Claims Adjudication Specialist Job in Bengaluru at Plum

Plum is hiring for the role of Claims Adjudication Specialist!

Responsibilities of the Candidate:

• Review and assess complex health insurance claims to determine coverage and eligibility for payment.
• Investigate and verify claim information, including policy details, medical records, and other relevant documentation.
• Work with Insurance companies to ensure all relevant claims are paid to the customer as per the terms agreed
• Help customers understand the complex medical requirements (wherever required) in ensuring a smooth claim processing
• Ensure compliance with regulatory requirements and company policies and procedures in the claims adjudication process.
• Provide guidance and support to junior claims adjudication specialists and other team members as needed.
• Collaborate with internal departments, in helping them resolve complex medical queries coming out of the Insurance claims..
• Act as a COE for medical queries within the organization
• Stay up to date on industry trends, best practices, and regulatory changes related to claims adjudication.

Requirements: 

• MBBS/BHMS/BDS and a good understanding of medical terminologies
• 2+ years experience in health claims processing/approval in domestic Insurance companies or TPAs
• Excellent communication skills
• Good negotiation skills
• Responsive, accountable and detailed oriented creative thinker with a strong bias for action