Health Insurance Claims jobs

Experience – 4 to 5 years

Job Location – Bengaluru

Shift – Night Shift (5.30 pm to 2.30 am IST)

The Senior Claims Associate role provides foundational support to the Claims team by managing timely and accurate intake, documentation, and administrative processing of workers’ compensation claims. This position plays a key role in maintaining service-level commitments, strengthening client relationships, and ensuring compliance with regulatory and carrier reporting standards.The role is non-adjusting and focuses on operational coordination, data accuracy, and service excellence. It serves as an entry point into the claims career path within Risk Management.

Roles and Responsibilities

• Assist in managing workers’ compensation claims from initial report through closure for designated clients.
• Partner with the appointed TPA to ensure compliance with service agreements, including:
• Reviewing basic claim details and supporting documentation.
• Monitoring reserves and ensuring adherence to Standard Service Instructions (SSIs).
• Provide clear status updates and route escalations when higher-level intervention is required.
• Support return-to-work follow-up and ensure client expectations are met throughout the claim lifecycle.
• Monitor critical claim-related deadlines, including wage filings, state form submissions, and medical updates.
• Assist the Claims Manager in preparing materials for claim reviews, carrier discussions, internal presentations, and departmental reporting.
• Identify and provide solutions for process gaps.
• Uphold privacy, confidentiality, and data governance standards.
• Assist in preparing materials for claim reviews, carrier discussions, internal presentations, and departmental reporting.
• Contribute to internal reporting, including loss runs, data validation, and performance metrics.
• Run recurring and ad hoc reports to validate data and identify discrepancies.

Required Qualifications

• At least 4-5 years of workers’ compensation claims experience
• At least 2 years of experience with master carriers and monopolistic state funds.
• Familiarity with workers’ compensation underwriting, claims, and loss control.

Required Skill Sets

• Working knowledge of workers’ compensation laws and state-specific requirements.
• Strong organizational and analytical skills with attention to detail.
• Effective communicator with strong interpersonal and customer service skills.
• Ability to manage multiple claims and deadlines in a fast-paced environment.
• Proficiency with claims management systems and Microsoft Office Suite.

Pay: ₹900,000.00 - ₹1,000,000.00 per year

Benefits:

• Paid sick time
• Paid time off
• Provident Fund

Work Location: In person