Insurance Claims Specialist

Job Title: Insurance Claim Specialist

Location: Bangalore

Experience: 1–3 Years

Job Summary:

The Insurance Claim Specialist will be responsible for managing end-to-end cashless insurance claim processes while ensuring effective patient handling and counseling. The role focuses on delivering a smooth, transparent, and stress-free experience for patients during hospitalization and discharge.

• Key Responsibilities:Handle end-to-end cashless insurance claim processing, including pre-authorization, approvals, and final settlements
• Coordinate with insurance companies and TPAs for claim submissions, approvals, query resolution, and follow-ups
• Manage patient and attendant interactions, explaining procedures, documentation, and claim status clearly
• Counsel patients on insurance coverage, co-payments, deductions, exclusions, and policy limitations
• Resolve queries raised by insurers/TPAs promptly to avoid delays or claim rejections
• Track and monitor claim status to ensure timely closure
• Verify insurance eligibility, policy details, and coverage before admission/treatment
• Coordinate with internal teams such as billing, front office, and medical records
• Maintain accurate documentation and claim records
• Ensure compliance with insurance guidelines and hospital policies
• Assist patients during discharge process by coordinating final approvals and settlements
• Prepare MIS reports and support audits when required
• Required Skills & Competencies:Strong knowledge of cashless health insurance claim processes
• Excellent patient handling and counseling skills
• Experience working with insurance companies and TPAs
• Strong communication skills (verbal & written)
• Ability to multitask and work under pressure
• High attention to detail and documentation accuracy
• Qualifications:Any Graduate (preferred)
• Diploma/Certification in Medical Billing / Healthcare Management / Insurance is an added advantage
• Grooming & Professional Conduct:Maintain a neat, clean, and professional appearance at all times
• Adhere to formal dress code and grooming standards
• Demonstrate professional etiquette, empathy, and courtesy in all interactions with patients and insurers