Individual Benefit Cashless, Claims
Core
Provide technical medical expertise for claims decisions, resolve customer enquiries, and manage healthcare services for policyholders.
Role type
Individual contributor medical claims adjudicator
Builds
Medical insurance claims resolutions and healthcare service management
Domain
Insurance / Healthcare
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical insurance knowledge, claims adjudication, medical documentation analysis, process improvement, confidentiality management, shift adaptability
Preferred skills
Nursing/medical science/hospital background, fast-paced environment adaptability, independent work, multi-tasking, critical thinking, problem-solving
Technologies
Microsoft Office, reporting tools
Responsibilities
Ensure completeness of Claims/Guarantee Letter Pre-certify documents, Adjudicate medical claims within authority limits, Establish covered medical insurance losses, Establish proof of loss by studying medical documentation, Ensure confidentiality of claims information, Identify process improvement ideas, Ensure claims are processed within specified turnaround time
Seniority
Mid-level, hands-on IC