maintain clear communication with all stakeholders and deliver
exceptional customer service
while adhering to all regulatory and compliance guidelines.
Key Responsibilities:
Process and manage health, motor (and non-motor insurance claims).
Review physical and digital claim files, verify documentation, and ensure proper file management.
Coordinate with insurers,
TPAs, internal/external surveyors
for claim updates and resolutions.
Respond to client queries, follow up for missing documents, and provide status updates.
Ensure timely claim processing within the defined
Turnaround Time (TAT).
Review settlement letters for any
errors or unjust deductions.
Facilitate
cashless claim approvals
through coordination with hospitals and internal cashless teams.
Assist clients in filing ombudsman complaints for unfairly rejected claims.
Maintain digital claim records and update closure entries in
Saiba.
Support
urgent cashless claims
during weekends or off hours when required.
Attend to
walk in queries
and provide personalized support to
HNI clients.
Outdoor Visits:
oVisit hospitals to support HNI clients during cashless claims.
oHandle claims processing in the absence of other team members.
oEnsure timely email responses and maintain digital records of all documents.
Qualifications
oGraduate (Preferred Insurance, Healthcare, or Business-related field).
oMinimum Experience 2 years in insurance claims processing.
oIn depth knowledge of
insurance policies, TPAs, claim life cycles,
and
regulatory compliance.
Key Skills:
oExcellent verbal and written
communication skills in English.
oHigh level of
accuracy and attention to detail.
oStrong
time management and organizational skills.
oAbility to work both
independently and in a team.
o
Customer centric
approach with a proactive problem-solving attitude.