Medical Claims Reconciliation Executive

About the Role

ViFin is an innovative financial technology company focused on transforming the healthcare and insurance sectors. The organization provides a common platform for industry partners and end customers to improve transparency and streamline interactions across the insurance ecosystem. By leveraging advanced technology, ViFin aims to simplify complex processes, enhance accessibility, and deliver more efficient services. The company is dedicated to improving user experience and fostering greater satisfaction for all stakeholders through its forward-thinking and customer-centric approach.

The Medical Claims Reconciliation Executive is a full-time, on-site role based in Chennai. This role is responsible for reviewing, reconciling, and validating medical insurance claims against policy terms, billing records, and supporting documentation.

Key Responsibilities

• Review, verify, and analyze hospital IP and OP claims reports using MS Excel.
• Prepare, maintain, and update Excel reports to track claim status, pending payments, and settlements.
• Create and analyze Pivot Tables to summarize claims data and generate MIS reports.
• Identify and follow up on unsettled or pending claims, particularly those outstanding for 15–30 days.
• Send payment request emails to TPA and insurance companies and follow up on claim settlements.
• Conduct direct visits to TPA offices and insurance companies whenever required to expedite pending payments.
• Coordinate with hospital departments, TPA representatives, and insurance companies to resolve claim-related queries.
• Maintain accurate records of payment requests, claim status, and follow-up activities.
• Prepare regular reports on pending claims, outstanding amounts, and settlement progress.
• Ensure timely follow-up and proper documentation to minimize claim settlement delays.
• Respond to inquiries related to claims.
• Generate reconciliation reports.
• Support process improvements to strengthen operational efficiency and compliance.

Requirements & Tech Stack

• MS Excel (including Pivot Tables, filters, and report preparation)
• Insurance platforms and claim management software
• Spreadsheets

Qualifications

• Strong analytical skills, including the ability to interpret data, identify discrepancies, and perform detailed reconciliations.
• Hands-on experience in claims handling and claims management within health insurance or healthcare revenue cycle processes.
• Customer service skills, with a focus on empathy, problem-solving, and maintaining professional relationships with stakeholders.
• Clear and effective communication skills, both written and verbal, to interact with customers, partners, and internal teams.
• Attention to detail, high level of accuracy, and strong organizational skills.
• Any graduate with relevant experience in claims follow-up, hospital billing, insurance coordination, or healthcare administration.
• Good understanding of hospital IP/OP reports and medical insurance claims processes.
• Excellent communication, coordination, and email-writing skills.
• Ability to manage multiple claims and follow up on pending payments effectively.
• Willingness to visit TPA offices and insurance companies as required.
• Bachelor’s degree in finance, commerce, healthcare administration, or a related field preferred.
• Prior experience in health insurance, TPA operations, or medical billing/reconciliation is an advantage.
• Experience in hospital claims processing and insurance payment follow-up.
• Knowledge of TPA procedures, health insurance claims, and claim settlement processes.
• Proficiency in Excel reporting, Pivot Tables, and data analysis.
• Ability to identify discrepancies and resolve claim-related issues.
• Good negotiation, problem-solving, and follow-up skills.

Location: Chennai

Position Type: Full-Time