Even Healthcare - Assistant Manager - Claims

Assistant Manager - Claims

Description:

About The Role

We are looking for a passionate and detail-oriented healthcare professional to join our Health Claims team.

This role is ideal for someone with a strong foundation in medical sciences and hands-on experience in health insurance claims adjudication, who thrives in a fast-paced, process-driven environment.

As part of the Health Claims vertical, you will play a critical role in managing cashless and reimbursement claims, ensuring accurate adjudication, driving operational excellence, and strengthening fraud and governance frameworksall while delivering a superior customer experience.

Key Responsibilities:

- Build, manage, and continuously improve cashless and reimbursement processes for both IPD and OPD claims, including governance and fraud-management frameworks

- Ensure accurate and timely claims adjudication in line with SOPs, internal guidelines, and policy terms & conditions

- Review medical documents and policy clauses to make sound, evidence-based claim decisions

- Drive innovation and process improvements to enable an exceptional customer experience

- Review, research, and recommend actions on appeals, grievances, and escalations related to claim denials or underpayments

- Monitor and improve critical claims metrics, including Turnaround Time (TAT), quality, productivity, and accuracy

- Collaborate closely with insurance partners and internal stakeholders to support both B2C and B2B claims operations

- Contribute to fraud detection and risk assessment through investigative analysis and data-driven insights

What Were Looking For:

- Mandatory qualification: MBBS / BHMS / BAMS / BDS

- Minimum 0.6 months to 3 years of experience in the Insurance or TPA industry with hands-on exposure to health claims adjudication

- Strong understanding of health insurance fundamentals, policy wordings, product features, and claims guidelines

- Ability to analyze and interpret large volumes of medical and insurance information accurately

- Close attention to detail with a strong investigative and analytical mindset

- Ability to take ownership, work independently, and make well-reasoned decisions

- Comfort working in a structured, office-based, and performance-driven environment

Work Environment:

We foster a collaborative, transparent, and supportive team culture, where ideas are encouraged, and learning is continuous.

Given the nature of claims operations and cross-functional collaboration, this role follows a Work from Office model.

Why Join Us:

- Opportunity to work at the intersection of healthcare and insurance

- High-impact role influencing customer experience and operational quality

- Exposure to complex medical and insurance decision-making

- Strong learning curve and growth within the health claims domain