Claim Operations Care.fi Technological Solutions

3.0 - 7.0 years

3 - 4 Lacs

Gurugram

Work from Office

Job Title: Associate - Claims Operations Care.fi is a new age Health fintech startup in Gurgaon, offering smart financing and claim management solutions to hospitals. With a focus on driving efficiencies through technology, Care.fi provides seamless financing and revenue cycle management solution for healthcare providers. The company has strong institutional investor backing and founders with over 20 years of experience in the industry. About the Role Department: Claims Processing / Operations Reports to: Team Lead / Operations Manager Location: Gurugram, Haryana Work Schedule: 6 Days Working We are seeking a diligent File Dispatch Associate with strong medical billing know-how and hospital experience. This role is crucial for our claims processing workflow, involving close collaboration with our AI-powered document review system. The primary responsibility is to assess claims and dockets filed daily, meticulously identifying missing documents and discrepancies to ensure each file is 100% complete and accurate before final dispatch. This position requires a keen eye for detail and specific knowledge of Indian government health schemes. What You'll Do The associate will be responsible for the final human audit of medical files processed by our AI system, focusing on completeness and correctness. Responsibility Area 1. Daily File Assessment Assess claims dockets daily to identify and flag any missing documents or discrepancies across the provided paperwork. Verify the AI's initial classification of Billing Type, Admission Nature, and Anesthesia Type. 2. Document Completeness Audit Core Documents: Ensure the presence and correctness of the Discharge Summary, Patient Feedback Forms, complete Indoor Case Papers (ICP), and both Final and Detailed Bills. Conditional Documents: Based on the case type, validate the presence of mandatory reports and notes, such as Investigation Reports, OT Notes, and Anesthesia Records. 3. Financial & Evidence Verification Billing Audit: Cross-reference the itemized bill with investigation reports to ensure all billed tests have supporting documents High-Value Items: For applicable cases, verify that required evidence for implants (invoices, stickers) and high-cost/chemotherapy medicines (invoices, wrappers) is present in the file. 4. Process Compliance Ensure every file strictly adheres to the medical review checklist before being dispatched Provide clear feedback on any errors or omissions found, contributing to system and process improvement. Maintain accurate logs of file status and reviews. What We're Looking For Required Qualifications Experience Hospital Experience: Prior experience working in a hospital setting (e.g., billing department, TPA desk, medical records) is mandatory Claims Processing: Experience in assessing medical or insurance claims is highly preferred. Knowledge Medical Billing Know-How: Strong, practical understanding of hospital billing processes, including package vs. itemized billing Insurance Knowledge: Must have working knowledge of major government health schemes, specifically Ayushman Bharat, CGHS, and ECHS . Skills Attention to Detail: Exceptional ability to spot errors, omissions, and discrepancies in dense medical documents. Computer Knowledge: Proficient in using computers, including Microsoft Office and other software for viewing and managing digital files. Communication Skills: Decent verbal and written communication skills for reporting and team collaboration. Personal Attributes Methodical & Organized: Ability to follow a checklist-driven process with high accuracy and consistency. Reliable & Accountable: A strong sense of responsibility for the quality and completeness of each file reviewed. Why Carefi Work on real problems that matter healthcare, payments, and patient journeys Small team = high ownership and fast learning Be part of a mission-driven, product-first culture Competitive compensation and flexible work setup (hybrid from Gurgaon)

Posted 2 weeks ago

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