Claims Executive

5 days ago


Indore India ICICI Lombard Full time

Job Description Key Responsibilities - Medical Review Claims Adjudication: - Assess and validate medical claims based on clinical documentation and policy coverage. - Interpret diagnostic reports, treatment plans, and prescriptions to determine claim eligibility. - Coordinate with internal medical teams to ensure accuracy in claims decision-making. - Customer Interaction Support: - Communicate with policyholders, hospitals, and third-party administrators (TPAs) to explain claim decisions in a clear and professional manner. - Handle escalated or complex customer service issues involving medical claims. - Offer support and guidance on claim submission processes and documentation requirements. - Compliance Documentation: - Ensure all claims are processed in compliance with IRDAI regulations and internal guidelines. - Maintain accurate records of claim assessments, approvals, denials, and communications. This job is provided by Shine.com


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