Claims Specialist

Company Description

Hire Vibe is a platform focused on recruitment, career development, and business consultancy, providing tailored solutions to meet the needs of businesses and professionals. We are looking for Claims Specialist for one of our clients, a leading MNC in Kochi.

We are seeking a Claims Specialist to review, evaluate, and process medical form requests with accuracy and professionalism. The role requires handling of submission forms, complete follow‑ups via outbound calls, and ensure timely, high‑quality service to both internal and external stakeholders.

2-4 years of experience in Insurance Voice Operations is a MUST.

Key Responsibilities

- Review and process Notice and Proof forms in line with company policies, guidelines, and regulatory requirements.
- Enter medical provider information accurately into claims processing systems.
- Identify discrepancies or missing details and conduct follow‑ups with providers, employers, or claimants through outbound calls.
- Ensure timely closure (adjudication) of follow‑ups to meet productivity and quality targets.
- Document all claim actions clearly and accurately within internal systems.
- Prepare, review, and finalize written communication for medical providers and claimants as per policy standards.
- Collaborate with Quality Assurance, Customer Support, and Medical Review teams to resolve complex cases.
- Escalate high‑risk or unusual cases to leadership or medical reviewers when necessary.
- Support continuous improvement by identifying trends, sharing feedback, and recommending process enhancements.

Qualifications:

- Graduates or post-graduates (Non Engineering Graduates)
- 2-4 years of experience in Insurance Voice Operations preferably in disability, health, or supplemental insurance claims
- Strong analytical and critical‑thinking skills with high attention to detail.
- Excellent verbal and written communication skills.
- Ability to work independently while meeting deadlines and quality standards.
- Proficiency in claims systems, Microsoft Office, and general computer applications.
- Strong organizational and time‑management skills.

Preferred

Skills:

- Experience in disability, health, or supplemental insurance claims.
- Background in healthcare administration, medical office operations, clinical support, or related fields.
- Strong familiarity with medical terminology and ability to review medical records or clinical documentation.
- Understanding of the U.S. healthcare system, insurance terminology, and claims processes.
- Knowledge of coding frameworks such as ICD and CPT.