Soma Capital Portfolio Jobs

Claims Specialist

Loop Health

Loop Health

Pune, Maharashtra, India
Posted on Thursday, February 23, 2023

We are hiring a Claims Specialist to help us maintain 100% retention and high-satisfaction in our health insurance clients. This person is customer-obsessed, is highly supportive and empathetic towards patients, and will help us scale our account management and client servicing teams in the years to come.

Roles and responsibilities

  • Serve as the main point of contact for Loop Health members for all claims related inquiries.
  • Guiding Loop Members for cashless and reimbursement process, quickly supporting them with all required information and helping them get their claim processed on time
  • Build relationships and familiarity with all TPAs and insurers to improve TATs and approval time
  • Serve as a POC of contact for any claims status, deductions, pre approvals etc.
  • Escalate issues in claims to TPA, conduct a root-cause analysis, and share with the client.
  • Coordinate with hospitals for resolution of claims issues.
  • Maintain a clean and useful claims tracker.
  • Flexible with rotating night shifts
  • Assist claims support team with any clarification needed

What you will do

  • 2+ years total work experience in health insurance claims at a broker or TPA
  • Patient-facing experience is preferred either at a clinic, medical tourism, hospital IPD department or Insurer/TPA claims team -Some fluency with technology
  • Willingness to travel to occasionally travel to client sites (conveyance is paid by company)
  • Strong understanding of the insurance and claims process.
  • Good understanding of policy wordings and keen eye for overturning deductions or denials
  • Education: Doctor (MBBS/ BHMS / BAMS / BDS)Strong oral and written communication skills
  • Fluency in English, Marathi, and Hindi
  • Passion to improve the Indian healthcare system