Claims Administrator - Insurance [Part time & full time]

We have exciting opportunities for the role of AVP- Claim Review.
Location: Mumbai - Prabhadevi
Interested candidate can share resume on [HIDDEN TEXT] with subject line AVP- Claim Review and share below details.

Current Salary
Expectation
Notice Period
Education (Full Time / part Time)

Role Overview
The Claim Review Specialist will be responsible for reviewing medical claim rejections, ensuring due diligence, and enhancing customer experience through accurate and accountable claim assessments. The role requires strong medical knowledge, analytical capability, and the ability to contribute individually across claim processes. The candidate will also act as a Customer Ambassador by maintaining service quality and process transparency.
Key Responsibilities
1. Claim Review
Review claim rejections in detail to ensure fairness and accuracy.
Conduct due diligence on all claims, with a strong focus on customer empathy and accountability therein.
2. Process Contribution
Act as an individual contributor for end-to-end claim processes.
Achieve and improve claim process efficiency and quality parameters.
Support claim operations and coordinate effectively with stakeholders.
3. Customer Advocacy
Represent the customer's perspective during claim assessment.
Ensure communication is clear, empathetic, and customer-centric.
4- Stakeholders Liaison
Required Skills & Knowledge
Strong understanding of underwriting (UW), claims evaluation, and medical/product knowledge.
Excellent communication skills (verbal & written).
Solid SOP (Standard Operating Procedure) understanding.
Ability to work independently and manage performance KPIs.
Must be able to work from office
Qualification
Medical background: **MBBS / BHMS / BUMS / BAMS** (preferred).
Experience in **Insurance and/or TPA** environments is desirable.
Minimum **10 years of experience** in claims operations or related medical review roles.

Regards,
Saba