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Role Description
As a Insurance Claims Underwriter at CareFi, you will be at the forefront of evaluating healthcare insurance claims using your deep clinical knowledge. You will be responsible for assessing the medical risks associated with claims while working closely with healthcare providers and business teams.
Your experience and expertise will ensure that all claims are processed efficiently, aligned with underwriting guidelines and compliant with both internal and external regulatory standards.
Key Responsibilities
· Claim Evaluation: Review and analyze medical records, health conditions and treatment plans to underwrite insurance claims efficiently and accurately. Check if the given treatment is covered under the said insurance policy or not
· Risk Assessment: Analyze the financial and clinical risks associated with claims, particularly for high-value and complex cases, ensuring appropriate decisions are made
· Team Oversight: Monitor the performance and efficiency of the clinical underwriting team, ensuring that all tasks are completed within established timelines and maintaining high service levels
· Strategic Input: Work closely with Business Unit (BU) heads, providing data-driven insights and feedback to support product improvement and new product development initiatives
· Bill validation: Make an approval letter as per the treatment and insurance coverage
· Escalations: Solve hospital escalation regarding approval amounts
Requirements:
· Minimum of 3 years in clinical underwriting, healthcare insurance, or a related role within the healthcare or insurance industries.
· Medical background (MBBS, BAMS, BHMS, BDS, B.Pharma) or a strong insurance background is preferred
· Proficiency in Microsoft Office, Microsoft skills, and tech tools
· Strong analytical thinker with a proactive, problem-solving mindset
· Excellent team collaboration skills and a strong work ethic
· Effective verbal and written communication abilities
· Willingness to work from office, 6 days a week
