Insurance Sales

Job Summary:

We are seeking a qualified and experienced medical professional with a strong background in health insurance claim settlement and customer service. The ideal candidate will leverage their clinical knowledge to evaluate and process health insurance claims efficiently while ensuring a high level of customer satisfaction. This hybrid role bridges the gap between medical accuracy, regulatory compliance, and empathetic customer support.

Key Responsibilities:

·         Medical Review & Claims Adjudication:

• Assess and validate medical claims based on clinical documentation and policy coverage.

• Interpret diagnostic reports, treatment plans, and prescriptions to determine claim eligibility.

• Coordinate with internal medical teams to ensure accuracy in claims decision-making.

·         Customer Interaction & Support:

• Communicate with policyholders, hospitals, and third-party administrators (TPAs) to explain claim decisions in a clear and professional manner.

• Handle escalated or complex customer service issues involving medical claims.

• Offer support and guidance on claim submission processes and documentation requirements.

·         Compliance & Documentation:

• Ensure all claims are processed in compliance with IRDAI regulations and internal guidelines.

• Maintain accurate records of claim assessments, approvals, denials, and communications.

Required Qualifications:

·         Education:

• MBBS, BDS, BHMS, BAMS, or equivalent medical degree. Postgraduate qualifications in healthcare or insurance are a plus.

·         Experience:

• Minimum 2–5 years of experience in health insurance, especially in claims processing, medical underwriting, or TPA operations.

• Proven track record of customer service experience in a healthcare or insurance setting.

·         Skills:

• Strong clinical judgment and attention to detail.

• Excellent communication and interpersonal skills.

• Proficient in claims management systems and MS Office.

• Ability to handle sensitive medical information with confidentiality and professionalism.

• It is a Full Time Field Sales job for candidates with 2 - 6 years of experience.