Assistant Manager Claims
Assistant Manager Claims
Posted on :
21-07-2025
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1 Vacancy
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Job Description
Job Title: Assistant Manager Claims
Location: Indranagar Bangalore
Department: Claims
Reports to: Claims Manager
Type: Full-time
Job Summary:
The Health Claims Associate is responsible for managing and processing health insurance
claims efficiently. The role involves assessing investigating and approving or denying
claims based on policy terms and conditions. This individual will work closely with healthcare
providers customers and third-party administrators (TPA) to ensure timely and accurate
claim settlements.
Key Responsibilities:
Processing:
Review and process health insurance claims in accordance with policy terms
and conditions.
Verify the completeness of claims documents and check for accuracy in the
submitted medical records.
Assess claim validity by ensuring all policy conditions and coverage limits are
met.
& Documentation:
Conduct detailed investigations for suspicious claims or cases that require
further validation.
Coordinate with third-party administrators (TPA) and hospitals for claim-
related information.
Keep records of all communications and actions taken on each claim.
& Provider Interaction:
Communicate with policyholders and healthcare providers to obtain missing
documentation or provide claim status updates.
Address customer inquiries concerns and complaints related to their health
insurance claims.
with Teams:
Collaborate with the underwriting and grievance teams to resolve issues or
discrepancies related to health claims.
Ensure proper follow-up on claims queries raised by the TPA or internal
stakeholders.
Settlement & Reporting:
Approve or reject claims based on the review of supporting documents and
adherence to policy.
Recommend partial settlements where applicable (e.g. exclusions co-
payments etc.).
Prepare daily weekly and monthly reports on claims processed pending or
settled for management.
Knowledge & Compliance:
Stay updated on health insurance policies regulatory changes and industry
standards.
Ensure compliance with legal requirements internal policies and company
guidelines.
Skills & Qualifications:
Bachelor s degree in a relevant field (healthcare) (BDS/BAMS/BHMS).
Experience: 1-3 years in health claims processing or health insurance-related roles
(Experience with TPAs / Insurer is a plus).
Strong analytical and decision-making skills with attention to detail.
Excellent communication skills for interacting with customers TPAs and hospitals.
Ability to work under tight deadlines and manage multiple claims simultaneously.
Proficient in Microsoft Office (Excel Word Outlook) and claims management
systems.
Knowledge of health insurance products and services is a plus.
Key Competencies:
Problem-solving and investigation skills.
Customer service-oriented.
Team collaboration.
Knowledge of medical terminology and insurance claim processe
e a summary of the role what success in the position looks like and how this role fits into the organization overall.
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Employment Type
Full Time
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