Dedicated Claims Specialist

We are looking for a  Dedicated Claims Specialist  with a strong background in medical and health insurance, particularly in  group medical corporate policies  . The ideal candidate should have 2-4 years of experience in claims processing or CRM roles.

Key Responsibilities :

• Handle end-to-end processing of reimbursement claims for group medical corporate policies.
• Provide excellent customer service by addressing claims-related queries via Freshchat, Ozontel, and Freshdesk.
• Analyze medical documentation, policy terms, and conditions to ensure accurate claim assessment and processing.
• Liaise with internal teams, insurers, TPA s, and hospitals to ensure seamless claims settlement and timely resolutions.
• Manage claims escalations, ensuring prompt resolution while maintaining a customer-centric approach.
• Required Skills : In-depth knowledge of corporate group medical insurance policies and claims processing.
• Ability to understand medical terminology, treatment procedures, and health-related documentation.
• Proficient in Ozontel, Freshdesk, or similar customer support and claims management tools.
• Strong communication and problem-solving skills to manage customer relationships and resolve issues effectively.
• Attention to detail to ensure accuracy in claim processing and documentation review.
• Ability to collaborate effectively with cross-functional teams, including insurance partners and hospital networks.
• Qualifications : Bachelor s degree in healthcare, insurance, or related field preferred.
• 2-4 years of experience in claims processing, CRM role preferably within group medical corporate policies.

Skills Required

CRM Tools, Medical Terminology