• Evaluates and processes claims in accordance with insurance policy terms and conditions, company policies and procedures according to productivity and quality standards.
• Ensures that targets are met for department Turnaround time, Quality and Productivity.
• Identify and report back any type of claims observation or issues that may affect the process.
• Collect and analyze claims data to identify and resolve errors, delayed claims, and processing issues. Providing recommendations to take steps to improve the claims processing quality standards and productivity.
• Analyze reports from the administrative software for provider and member utilization trends and identification of areas requiring further management.
• Support the Team leader / Manager in implementation of quality assurance programs in order to maintain standards of quality and minimize fraudulent cases.
• Handling medical related call queries.
• Maintain confidentiality with regard to the information being processed, stored or accessed.
• Completes other projects and duties as assigned.
• Should be willing be to work shifts (morning, evening and night shifts)
• Must be an MBBS graduate (no other medical related education will be accepted)
Job Description :
To ensure customer service and support all operations. To create customer delight at every interaction.
Interacting with external customers and internal customers and addressing their queries, requests and complaints.
Committed TATs are met consistently
Complaints Management- addressing customer complaints at the branch, system updation, coordination with Sales/HUB/ other functions for resolution.
Refunds processing and dispatch
Undelivered policy documents tracking and management.
Maintenance of all files and registers.
New Business Processing:-
Handling end to end New business processing starting from creation of Client id,Case start up, New business login, Follow up for policy issuance, Quality Check
Follow up with HUB for policy issuance of pending cases