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

• Claims 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.

• Investigation & 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.

• Customer & 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.

• Coordination 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.

• Claims 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.

• Policy 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, insurance) (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.

Skills: health,microsoft office,health claims processing,insurance,health insurance,claims management systems,insurance claim processes,analytical skills,medical terminology,decision-making skills,tpa,healthcare,communication skills