The Medical Claim Processor is responsible for end-to-end processing of medical insurance claims (reimbursement), ensuring accuracy, compliance with policy terms, and adherence to turnaround time (TAT). This role requires close coordination with hospitals, customers, internal teams, and third-party administrators to deliver timely and efficient claim settlements.
The Medical Claim Processor plays a critical role in ACKO by ensuring seamless claim processing, customer satisfaction, and financial stability. They are expected to work efficiently under pressure, manage multiple tasks simultaneously, and maintain high levels of accuracy and productivity.
Skills & QualificationStrong analytical skills, with the ability to review and verify claim details for accuracy and compliance.
Excellent communication skills, with the ability to effectively collaborate with hospitals, customers, internal teams, and third-party administrators.
Ability to work efficiently under pressure, manage multiple tasks simultaneously, and maintain high levels of accuracy and productivity.
Proficiency in insurance claims processing software, with the ability to adapt to new systems and technology.
Knowledge of medical billing and coding systems, including ICD-10 and CPT.
Strong problem-solving skills, with the ability to identify and resolve claim-related issues in a timely and efficient manner.
Ability to maintain accurate records and reports, with a strong attention to detail and organizational skills.
End-to-end processing of medical insurance claims (reimbursement), ensuring accuracy, compliance with policy terms, and adherence to turnaround time (TAT).
Collaborate with hospitals, customers, internal teams, and third-party administrators to deliver timely and efficient claim settlements.
Review and verify claim details for accuracy and compliance, identifying and resolving any discrepancies or errors.
Manage multiple claim files simultaneously, prioritizing tasks and meeting deadlines to ensure timely claim settlements.
Communicate effectively with customers, hospitals, and internal teams to provide timely updates on claim status and resolve any issues or concerns.
Maintain accurate records and reports, including claim status, payments, and customer interactions.
Stay up-to-date with changing policy terms, regulations, and industry best practices, applying this knowledge to improve claim processing efficiency and accuracy.
Participate in quality improvement initiatives, identifying areas for improvement and implementing changes to enhance claim processing efficiency and customer satisfaction.
Skills Required
- Strong analytical skills to review and verify claim details for accuracy and compliance
- Excellent communication skills to collaborate with hospitals, customers, internal teams, and TPAs
- Ability to work efficiently under pressure, manage multiple tasks, and meet deadlines
- Proficiency in insurance claims processing software
- Knowledge of medical billing and coding systems, including ICD-10 and CPT
- Strong problem-solving skills to identify and resolve claim-related issues
- Ability to maintain accurate records and reports of claim status, payments, and interactions
What We Do
ACKO, launched in 2016, is a tech company which is solving real-world problems for customers, starting with insurance. We are India’s first digital-native insurer and have meaningfully redefined the insurance category. As a new-age brand, ACKO has brought the customer into the focus with fair pricing, convenience, and superior customer experience. ACKO was founded by Varun Dua and Ruchi Deepak. Varun is a serial fintech entrepreneur who has had extensive experience in the insurance industry spanning over two decades. Prior to this, he was CEO and Co-Founder of Coverfox Insurance Broking. Ruchi has worked in financial services in Mumbai and London with organizations such as Franklin Templeton and venture capital firm Matrix Partners. ACKO is targeted in its approach and operates in the Auto insurance, Embedded Insurance (bite-sized contextual coverages like mobile insurance), and Health Insurance sectors. As a customer-first company serving the digitally savvy, ACKO’s value proposition of ‘Welcome Change’ highlights the offerings of the company that make insurance simple and hassle-free. With features such as zero commission, zero paperwork, instant renewal, same-day claim settlements, and app-based updates on claims, ACKO is a 'Welcome Change' from traditional insurers. The company has pioneered the D2C model for insurance in India and empowers customers to choose the right product based on their requirements at the best price, at the click of a button with zero paperwork. ACKO has recently raised USD 450+ million to date and are backed by private equity majors such as General Atlantic and Multiples private equity, top venture capitalists such as Accel, Elevation, and Lightspeed Multiples, along with Amazon, Canada’s largest Pension Fund (CPPIB) amongst others. The company has grown at a CAGR of 88% in the last 4 years, served 75+ million customers and has issued ~900 million policies till date. Check our website - www.acko.com to know more about us.
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