Claims Follow-up

Job Description – Executive | Claims Follow-up (Reimbursement Claims)

Location - Gurugram

- Manage reimbursement claim portfolios from submission to final settlement.

- Conduct regular follow-ups with insurance companies and TPAs through calls, emails, and claim portals.

- Track claim status and ensure settlements are completed within defined TAT.

- Resolve insurer queries by coordinating with hospitals, patients, CRMs, and internal teams.

- Ensure timely submission of pending documents and deficiency responses.

- Escalate delayed or high-value claims to senior stakeholders whenever required.

- Maintain accurate claim updates in the CRM and internal systems.

- Monitor aging reports and prioritize pending claims to reduce outstanding inventory.

- Analyze rejection, short settlement, and deduction reasons and initiate corrective actions.

- Coordinate with the Policy Decoding, Clinical, and Financial teams for claim resolution.

- Maintain strong relationships with insurance companies, TPAs, and hospital stakeholders.

- Prepare daily productivity reports, and claim status reports.

- Ensure compliance with internal SOPs and insurance guidelines.

Key Performance Indicators (KPIs)

- Claim Settlement TAT

- Daily Follow-up Productivity

- Claim Closure Rate

- Reduction in Aging Cases

- Query Resolution TAT

- Recovery Percentage