Sr. Associate

ABOUT USACKO is the protection destination for over 200 million tech-savvy families across India, protecting their families, assets and money. Launched in 2016, ACKO started by reimagining insurance, making it simple, hassle-free and customer-first. Today, our mission goes beyond that: we aim to touch the lives of 1 million users, building products that solve real-world problems with technology at the core.We are not just another insurance company, our DNA is product-tech, and our approach is bold, innovative, and digital-first. From zero commission, zero paperwork, and instant renewals to same-day claims settlements and app-based tracking, ACKO is a Welcome Change from traditional insurers.But what truly sets us apart? Our people. At ACKO, every Acker's voice and ideas matter. We're a vibrant, inclusive team of creators, thinkers, and doers, building products that redefine protection while ensuring each Acker grows, thrives and does meaningful work.Join us at ACKO, where bold ideas, real impact and tech-driven innovation redefine protection and peace of mind - and where YOU can make a real difference in people's lives. ACKO is a product-tech company, launched in 2016, solving real-world problems for customers, starting with insurance. And as a customer-first organization serving the digitally-savvy, ACKO's value proposition of ʻWelcome Change' focuses on offerings that make insurance simple and hassle-free With features such as zero commission, zero paperwork, instant renewal, same-day claim settlements, and app-based updates on claims, ACKO is a 'Welcome Change' from traditional insurers.Having said that, we are not just another conventional insurance firm, or the people consulted solely for "claims" Anchored in a tech-centric philosophy, ACKO's approach fuels innovation, empowering us to develop comprehensive products that cater to every aspect of our customers' insurance requirements. And while we are at it, we put our Ackers at the heart of everything we do. We're not your typical 9-to-5 workplace; we're a vibrant and inclusive bunch of innovators and creators making sure every Acker's idea matters, their voice is heard, and their growth is part of our mission.About JobWe are looking for a Sr. Associate - OPD Claims to manage end-to-end processing of medical insurance claims. The role involves evaluating and verifying claims, assessing medical documents, ensuring compliance with IRDAI guidelines, resolving discrepancies, and identifying potential fraud. You will also interact with customers to explain policy details, provide claim updates, and deliver timely resolutions while maintaining quality and compliance standards.Skills & QualificationProficiency in spoken English and Hindi (mandatory)Strong customer service skillsBasic medical knowledgeWorking knowledge of insurance claims with relevant experienceStrong problem-solving and analytical skillsProficiency in MS Office (basic)ResponsibilitiesEvaluates and processes claims in accordance with company policies, procedures, and quality standards.Examines medical documents and assesses claim admissibility.Maintains production and quality standards consistently based on quality control expectations.Demonstrates adaptability in cross-training and multitasking.Communicates with customers to explain policy terms and conditions and claim details.Reviews medical claims and verifies information for accuracy.Examines claims for potential fraud.Resolves discrepancies and other issues.Complies with company regulations and policies.Performs other tasks as required.Possesses basic knowledge of IRDAI guidelines.Processes claim payments.Responds to customer queries and provides updates on claim status.Conducts investigations when necessary, gathering additional information to determine claim validity.Delivers exceptional customer service to policyholders by resolving issues and answering questions in a timely manner.