About Even Healthcare
Even Healthcare is revolutionizing the healthcare industry by providing comprehensive and affordable healthcare solutions to corporations and teams across India. We are on a mission to create a seamless healthcare experience for individuals and families by building a strong network of healthcare providers.
We partner with organizations to deliver healthcare solutions that support employee wellbeing, helping companies provide accessible and high-quality OPD healthcare benefits to their workforce.
Key Responsibilities
- Process and adjudicate OPD and wellness claims in line with company policies and defined SLAs.
- Verify claim documents, including medical bills, prescriptions, and supporting records, ensuring accuracy and completeness.
- Coordinate with internal teams (customer experience, medical, and operations) to resolve discrepancies or gather additional information.
- Act as a point of contact for all client facing roles within the team to help with any corporate client with claim-related queries, providing clear and timely updates.
- Ensure accurate claim settlement, including approvals, rejections, and reimbursements, with proper documentation.
- Identify patterns in claim rejections, delays, or errors and recommend process improvements specifically to identify fraudulent intent or cases of misrepresentation.
- Maintain detailed records of claims processed and interactions in the CRM or claims management system by personally tracking any anomalies.
- Ensure compliance with internal policies, partner guidelines, and regulatory requirements.
- Support audits and reporting by providing necessary data and documentation.
Requirements
- 0-2 years of experience in claims processing, health insurance, TPA operations, or a
similar role. Medical or Allied degrees preferred.
- Basic understanding of Medical terminologies, OPD claims, wellness benefits, and health insurance processes in India are preferred.
- Strong attention to detail with the ability to review and validate documents accurately.
- Good communication skills both written and verbal to handle client and internal queries effectively and send out any communication to clients directly when required.
- Ability to manage multiple types of claims simultaneously in a fast-paced environment, with experience in adjudicating 100+ OPD claims daily.
- Familiarity with claims management systems or CRM tools is a plus.
- Problem-solving mindset with a focus on accuracy, efficiency, and customer satisfaction with the highest possible data sanity maintained.
- Collaborative attitude and willingness to learn and grow within the team.
Skills: claims management,health insurance,b2b
