Sr Analyst - Claims Specialist

Artex Risk Solutions; Mumbai; On-site; INR 500,000 - 700,000; Full time

Job summary

Artex Risk Solutions in Mumbai seeks experienced claims professionals to focus on processing insurance claims, validate members and provider information, and determine accurate payment criteria for settling claims. You will contribute as a team member under supervision and build domain and technical skills while maintaining productivity and quality standards.

This role involves handling complex projects, scrutinizing medical documents, and mentoring junior colleagues to ensure accurate

Qualifications

• University degree or equivalent experience.
• Minimum 5 years of prior relevant experience.

Responsibilities

• Process insurance claims and validate members, provider and other claims information.
• Determine accurate payment criteria for settlements based on policy and procedures.
• Maintain productivity goals, quality standards and aging timeframes; scrutinize medical claim documents and settlements.
• Participate in settlement of disputes and prepare case recovery through negotiations with third parties and providers.
• Work as a fully contributed team member under broad supervision.
• Build domain expertise along with technical skills.
• Handle complex projects not routine, using standard concepts and judgment.
• Mentor junior team members and contribute to coaching others.

Education

University Degree or equivalent experience

Job description

Responsibilities

• Professionals in this group focus on processing insurance claims.
• They validate members, provider and other claims information.
• Professionals determine accurate payment criteria for clearing pending claims based on defined policy and procedure.
• They maintain productivity goals, quality standards and aging timeframes and scrutinize medical claim documents and settlements.
• They are involved in settlement of disputes and preparing case recovery through negotiations with the third party and providers.
• Professionals in this group work as fully contributed team member under broad supervision.
• They further build up on domain expertise along with technical skills.
• They work on complex projects which are not similar or routine based using standard concepts and principles using their knowledge and judgement.
• They require a professional degree along with many years of work experience and are responsible for coaching/mentoring junior team members.

Qualifications

• Typically requires a University Degree or equivalent experience and minimum 5 years of prior relevant experience.