Job Description


About the Company



Claim Assessment & Processing: Evaluate claims (cashless/reimbursement) as per policy terms, medical documents, and regulatory guidelines, ensuring accurate adjudication.



About the Role



Coordination & Communication: Liaise with TPAs and internal teams; issue queries, approvals, and repudiation communications in a timely to TPA & Customer.



Responsibilities



  • Compliance & Documentation: Ensure adherence to SOPs, IRDAI norms, and maintain complete audit-ready documentation with proper record of all claim actions.
  • Quality & TAT Management: Process claims within defined turnaround time as per regulatory & internal guidelines while maintaining high accuracy and minimizing errors or rework.
  • Issue Resolution & Escalation Handling: Address discrep...

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