Health Claims | B. Pharma

Tata AIG General Insurance Company; Dadri; Presencial; INR 300.000 - 520.000; Jornada completa

Descripción de la vacante

Tata AIG General Insurance Company is seeking a Health Claims Analyst with a B. Pharma degree to review and process health insurance claims. You will analyze medical records, verify admissibility, and coordinate with hospitals, TPAs, and policyholders to ensure timely settlements.

The role requires strong medical terminology knowledge, analytical and documentation skills, and proficiency in MS Office. Join a fast-paced medical claims environment in India.

Formación

• B. Pharma degree mandatory.
• 0-3 years of experience in health insurance claims, TPA, hospital operations, or medical underwriting preferred.
• Good understanding of medical terminology, diseases, treatments, and pharmaceuticals.
• Strong analytical, communication, and documentation skills.
• Proficiency in MS Office and claim processing systems.

Responsabilidades

• Review and assess health insurance claims as per policy terms and medical guidelines.
• Analyze medical records, prescriptions, diagnostic reports, and hospitalization documents.
• Verify claim admissibility and identify discrepancies, inconsistencies, or potential fraud.
• Coordinate with hospitals, policyholders, TPAs, and internal stakeholders for claim processing.
• Ensure timely settlement or repudiation of claims within defined TATs.
• Maintain accurate claim documentation and update claim management systems.
• Provide medical opinion and interpretation on treatment protocols, medications, and procedures.

Conocimientos

Medical terminology

Analytical skills

Documentation

MS Office

Educación

B. Pharma degree

Herramientas

Claim processing systems

Descripción del empleo

Key Responsibilities:

• Review and assess health insurance claims as per policy terms and medical guidelines.
• Analyze medical records, prescriptions, diagnostic reports, and hospitalization documents.
• Verify claim admissibility and identify discrepancies, inconsistencies, or potential fraud.
• Coordinate with hospitals, policyholders, TPAs, and internal stakeholders for claim processing.
• Ensure timely settlement or repudiation of claims within defined TATs.
• Maintain accurate claim documentation and update claim management systems.
• Provide medical opinion and interpretation on treatment protocols, medications, and procedures.

Eligibility:

• B. Pharma degree (mandatory).
• 0-3 years of experience in health insurance claims, TPA, hospital operations, or medical underwriting preferred.
• Good understanding of medical terminology, diseases, treatments, and pharmaceuticals.
• Strong analytical, communication, and documentation skills.
• Proficiency in MS Office and claim processing systems.

Desired Skills:

• Attention to detail and accuracy.
• Ability to interpret clinical and policy-related information.
• Customer-centric approach with problem-solving mindset.
• Ability to work in a fast-paced claims environment.