Health Claims Associate - 12 months Contract

Protiviti India; Bengaluru; On-site; INR 300,000 - 420,000; Full time

Job summary

Protiviti India is seeking a Health Claims Associate to join our Bangalore area operations. You will conduct in-depth assessment of outpatient and inpatient medical claims, ensuring accuracy, timely responses, and adherence to policy contracts.

You will collaborate with internal teams and customers, maintain turnaround times, and use AS400/Salesforce and MS Office to support claim processing. 1–2 years of insurance experience is preferred, with strong communication and analytical skills.

Qualifications

• 1–2 years of related work experience in the insurance industry.
• Experience handling outpatient and inpatient health claims is preferred.
• Knowledge of AS400 and Salesforce is advantageous.
• Proficient in Microsoft Office applications.

Responsibilities

• Conduct in-depth assessment of outpatient and inpatient medical claims per policy guidelines.
• Manage emails and phone inquiries timely.
• Ensure claims are assessed correctly and approved within authority limits.
• Conclude settlements within agreed Turnaround Time (TAT).
• Investigate and resolve technical claim issues.

Skills

Communication

Analytical skills

Interpersonal skills

Customer service

Team player

Shift flexibility

Education

Diploma or Degree (any discipline)

Tools

AS400

Salesforce

MS Office

Job description

Health Claims Associate

Principal Accountabilities and Responsibilities (e.g., for Business, Customers and Stakeholders; internal control environment, etc.)

• Conduct In-depth assessment of Outpatient (70%, TAT 14 days) & In-patient Medical (30%, TAT – 21 days) claims in accordance with policy contract and guidelines
• Ensuring emails and telephone call inquiries are well-managed and responded in a timely manner
• Ensuring the claim is assessed correctly in accordance with policy contracts and guidelines and approved within the Authority Limit given.
• Ensuring claim settlement is concluded within the agreed Turnaround Time (TAT)
• Investigate and escape technical claim issues as and when experienced

Leadership and Teamwork

• Continuous communication with both internal and external customers and providing the required support with the objective of providing quality claim service experience
• Assist in providing necessary information and ad-hoc assignments to Senior Manager / Manager to allow for accurate and timely submission of reports to management.

Functional Knowledge

• A recognized Diploma or Degree in any discipline
• Minimum of 1 – 2 years of related work experience in the insurance industry, preferably experience with handling Outpatient and inpatient health claims
• Knowledge of AS400 and Salesforce an advantage
• Proficient in Microsoft Office application.

Others

• Excellent verbal and written communication skills and interpersonal skills
• Able to work independently and a fast learner, able to grasp processes and systems quickly
• Able to multi-task and work under pressure to meet tight deadlines in a fast-paced environment
• Strong customer orientation, team player
• Flexibility to work shifts.
• Ability to build rapport with and relate to a wide range of people.
• Strong analytical and problem-solving skills along with being organized, and structured. methodological and assertive.
• Strong interpersonal and customer servicing skills.