Claim Processing Executive (Health Insurance)- Delhi

We are looking for a detail-oriented and process-driven Claim Processing Executive (CRM) to handle health insurance claims efficiently and accurately. The role involves verifying claim documents, coordinating with hospitals/TPAs/customers, ensuring policy compliance, and processing claims within defined timelines while maintaining high service standards.

Key Responsibilities

Review and process health insurance claims as per company policies and regulatory guidelines.

Verify claim documents including hospital bills, discharge summaries, prescriptions, investigation reports, and policy details.

Coordinate with hospitals, TPAs, insurance companies, and customers for additional documentation or clarifications.

Ensure claims are processed within agreed turnaround time (TAT).

Identify discrepancies, incomplete documentation, or fraudulent claims and escalate appropriately.

Maintain accurate records and update claim status in the system.

Handle customer queries related to claim status, approvals, rejections, and settlements.

Ensure compliance with internal processes, IRDAI regulations, and company policies.

Prepare MIS reports and maintain claim processing data.

Work closely with underwriting, customer support, and finance teams for smooth claim settlement.

Required Skills & Competencies

Good understanding of health insurance claim processes.

Knowledge of medical terminology and hospital documentation preferred.

Strong attention to detail and analytical skills.

Good communication and coordination skills.

Ability to work under pressure and manage deadlines.

Proficiency in MS Excel and claim management software.

Strong documentation and record-keeping abilities.

Eligibility Criteria

Graduate in any discipline.

Prior experience in health insurance claims processing/TPA/hospital insurance desk preferred.

Freshers with relevant knowledge or certification may also apply.

Experience

0–3 years of experience in health insurance claims processing.

Location- Delhi, India.

Working Days & Timings

Mon - Sat; 9.30am to 6.30pm

Preferred Industry Background

Health Insurance

TPA (Third Party Administrator)

Hospitals / Healthcare

Insurance Broking Companies

Pay

₹22,000.00 - ₹27,000.00 per month

Benefits

Paid sick time

Paid time off

Provident Fund

Work Location

In person