Claims Processing Team Lead

Vidal is hiring for Claims-Executive/Team leader Level

Work Location: Jaipur

Work from Office only

Key Responsibilities

Claim Review & Validation

- Examine submitted claims for completeness and accuracy
- Verify policy coverage and eligibility- Identify discrepancies or missing documentation

Claims Processing

- Enter and adjudicate claims in the system (cashless & reimbursement)
- Calculate payable amounts as per policy terms- Ensure timely processing within defined SLAs

Stakeholder Communication

- Liaise with policyholders, hospitals, and insurers for claim clarifications
- Respond to queries and provide claim status updates- Coordinate with Preauth and Customer Care teams

Documentation & Compliance

- Maintain detailed records of claims and actions taken
- Ensure adherence to IRDAI guidelines and internal SOPs- Flag potential fraud or irregularities for investigation

Reporting & Analysis

- Generate daily/weekly/monthly claim reports
- Track claim trends and highlight recurring issues- Support audits and internal reviews with accurate data

Skills & Competencies

• Strong attention to detail and data accuracy
• Familiarity with medical terminology, ICD/CPT codes
• Proficiency in claims software (Portal)
• Effective communication and problem-solving skills
• Ability to manage sensitive information with discretion

Experience Required

• 2–3 years of experience in claims processing within the TPA or Health Insurance domain
• Exposure to group health policies and coordination with hospitals or corporate clients is preferred

Interested candidate can connect 9971006988

Job Types: Full-time, Permanent

Pay: ₹22,000.00 - ₹25,000.00 per month

Experience:

• total work: 1 year (Preferred)

Work Location: In person