Star Health & Allied Insurance - Assistant Manager - Claims Legal

Assistant Manager - Claims Legal

Role : Insurance Operations

Industry Type: Insurance

Department: BFSI, Investments & Trading

Employment Type: Full Time, Permanent

Role Category: General Insurance

List of Responsibilities:

- Team Handling: FLP, Billing, Combined, FA, DMS

- Specific Geography Responsibility for Coordination and Claims Processing/ Marketing Escalations/ Claims Escalations from All Verticals / IT Co ordination

- DAC/Audit: Response /Rectification /Counselling along with OH

- Payment query Pending

- TAT Monitoring

- Reimbursement Claims Processing

- Tabulation / Arithmetic Calculations checks as per the agreed Terms/Policy Terms of Reimbursement File

- Coordination with Medical Processors

- Referring back for insufficient documents /Rejection

- Cashless Claim Processing

- Tabulation / Arithmetic Calculations checks as per the agreed Terms/Policy Terms

- Coordination with Medical Processors

Job Description:

- Communicating with insurance agents and beneficiaries.

- Preparing claim forms and related documentation.

- Reviewing claim submissions and verifying the information.

- Recording and maintaining insurance policy and claims information in a database system.

- Determining policy coverage and calculating claim amounts.

- Processing claim payments.

- Performing other clerical tasks, as required.

Job Qualifications and Requirements:

- At least 4 years of experience as a claims processor or in a related role.

- Working knowledge of the insurance industry and relevant federal and state regulations.

- Computer literate and proficient in MS Office.

- Excellent critical thinking and decision-making skills.

- Good administrative and organizational skills.

- Strong customer service skills.

- Ability to work under pressure.

- High attention to detail.