Specialist - Claims

7 days ago


Mumbai, Maharashtra, India Edelweiss Tokio Life Full time

Job Purpose

·To ensure that insurance claims are handled efficiently and that payment for valid claims are made to the nominee / beneficiary

Key Responsibilities

Responsibilities

·To handle claim assessment and control the process within TAT

·To analyze the case and trigger investigations wherever necessary

·To ensure appropriate scanning of claim documents for fraud check

·To respond to claimant queries / mails properly with prompt action

·To ensure client servicing, prompt reply, action initiation

·To ensuring payment of claim to the correct nominee/beneficiary

·To identify and mitigate the risk in discussion with manager

Specific Authorities( Financial & Non Financial)

·Investigation trigger of Claims for appropriate Assessment

·Appropriate assignment of cases to Reinsurance for Opinion

·Preparation of letters in line with Company policy

Key Performance Indicators

·Accuracy in Claims Assessment & Payout = %

·Customer Management (Email/Calls) with NPS > 50

·Managing Reporting, Compliance and Audit = %

Job Requirements

Qualifications

Graduate/Post Graduate (Preferably in Finance or Statistics)

MBA preferred

Experience

0-6 years of relevant experience

Functional Competencies


• Claims & Risk assessment


• Reporting, Compliance and audits


• Strong background in life insurance Claims


• Possesses understanding trends that affect Claims Function in insurance

Behavioral Competencies


• Good communication and interpersonal skills


• Analytical skills


• Collaboration


• Business Acumen

Key Interactions

Internal

Nature or purpose of interaction

F&A, MIS team

·Daily coordination with finance/accounts team

·Automation requirement discussion

·Data from system MIS/Reports

External

Nature or purpose of interaction

IDRA, clients

·To provide MIS/Reports to IRDA

·To understand IRDA guidelines and updates

·To meet claimant

Documented By

Lead – Lead Claims

Approved By

Head – PS/Fin Ops & Claims

HR certification By

Vice President HR



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