Specialist - Insurance Operations - C Level

Mercer is seeking candidates for the following position based in the Noida office.

Specialist – Insurance Operation (Grade C1)

What can you expect?

We are looking to hire a Specialist in the Healthcare eligibility checks, running various reports and confirming the reports logic with the client requirements, Claims Adjudication and email enquiries Team.

The role will be responsible for uploading the data set received from clients that may/ may not requires data changes/ updates, validating the proration calculations done by the Mercer tools or at times completely manual calculations, data validation/ reconciliation from various excel files, running various data logics to verify the plan rules & eligibility check of the employee basis the agreed eligibility rules with client. This role also demands to validate the output generated through various reports and the report rules and logic agreed with the client. The role also demands to resolve email enquiries of the employees related to settlement disputes, claims status, estimation of benefits coverage, product coverage etc.

The role also may be responsible for validating the claims adjudication of medical claims for the employees of our clients based in Singapore and other Asia countries in addition to the above requirements.

What is in it for you?

• Medical insurance, personal accident insurance, group term life insurance from the day you join us.
• Holidays (As Per Location)
• Shared Transport (Provided the address falls in service zone)

We will count on you to:

• Manage huge data sets and validation/ reconciliation of data from multiple data files to get the desired output.
• Able to verify the tool input/ output for proration and eligibility checks as per client plan rules.
• Validate various insurers decision on settlement of health claims – verification of bills under various health product.
• Email enquiries handling for health insurance products – policies like GOC, GOS, GHS, and GBT etc. (Not Mandatory)
• Updating all documentation (e.g. SOP, client exception tracker etc.) and training of team members
• Drive the culture of First Time Right
• Preparation of Month end/Weekly/Daily Reports
• Support self-development (cross trainings, process training, soft skill trainings etc.)
• Support all projects and quality initiatives – Process improvement ideas.

What you need to have: 

• Minimum 3-5 years’ experience
• Should be good/ proficient in MS Excel to perform basic and medium complex calculations related to prorated benefits for new hires, terminations, claims payout, refunds, and deductions. Should be able to manage data sets and compare these with multiple excel files to get the correct output per the client’s requirements (data sets, reconciliations, census)
• Significant experience purely in healthcare claims and eligibility rules management - verification of bills under various health products, eligibility rules as per the client requirements (Not Mandatory)
• Exceptional written & verbal communication skills
• Experience in Email query handling for health insurance products – policies like GOC, GOS, GHS, GBT etc (preferred not mandatory)
• Experience in SOPs updation.
• Graduate (any stream)

Note: Applicants should be flexible with shifts

What makes you stand out?

• Well-developed Healthcare Claims Management skills and the demonstrated ability to work in a globally matrixed and significantly multi-geography, multi-cultural offshore service delivery environment.
• Excellent Communication Skills both written & verbal.
• Executive presence that conveys composure and confidence in all situations
• Strong analytical, research and problem-solving skills, attention to details

Mercer believes in building brighter futures by redefining the world of work, reshaping retirement and investment outcomes, and unlocking real health and well-being. Mercer’s more than 20,000 employees are based in 43 countries and the firm operates in over 130 countries. Mercer is a business of Marsh McLennan (NYSE: MMC), the world’s leading professional services firm in the areas of risk, strategy and people, with more than 85,000 colleagues and annual revenue of over $23 billion. Through its market-leading businesses including Marsh, Guy Carpenter and Oliver Wyman, Marsh McLennan helps clients navigate an increasingly dynamic and complex environment. For more information, visit mercer.com. Follow Mercer on LinkedIn and X.

Marsh McLennan is committed to embracing a diverse, inclusive and flexible work environment. We aim to attract and retain the best people and embrace diversity of age, background, caste, disability, ethnic origin, family duties, gender orientation or expression, gender reassignment, marital status, nationality, parental status, personal or social status, political affiliation, race, religion and beliefs, sex/gender, sexual orientation or expression, skin color, or any other characteristic protected by applicable law.

Marsh McLennan is committed to hybrid work, which includes the flexibility of working remotely and the collaboration, connections and professional development benefits of working together in the office. All Marsh McLennan colleagues are expected to be in their local office or working onsite with clients at least three days per week. Office-based teams will identify at least one “anchor day” per week on which their full team will be together in person.