Health Claims Specialist
4 days ago
KRAs:
Effective coordination with multiple stakeholders i.e. distributors / sub-brokers, end-clients & the insurance companies to resolve any query, claim & grievance
Scrutiny of policy documents for correctness & ensure all clauses are incorporated (as requested by clients)
Serve as a point of contact for clients during claims, providing clarifications on policy terms and conditions
Checking claim validity, registration of claim, sending checklist of requirements with claim form & addn. docs required, including bank details (Police FIR in case of Accident Claims)
Scrutiny of claim documents/form; resolve the same with clients/partners
Assess claim documents before forwarding to TPAs or insurance companies to ensure they are complete and meet the insurer's requirements
Resolve queries raised by the insurance companies to expedite the claim process
Inform clients on deductions (if any)
Follow up with TPAs/Insurance companies to ensure claims are processed within the agreed TAT (Turnaround Time).
Issuance of discharge voucher for obtaining client signatures
Making payment and final claim settlement
Maintain & Update Claim MIS for all clients on a weekly basis
Other Requirements:
Certification/Diploma from Insurance Institute of India is preferred
Proficient in MS Excel, Emails for managing claim-related data and documentation
Ability to prepare and maintain complex MIS reports with accuracy and attention to detail
Familiarity with insurance claims software & tools used for policy & claim mgmt. is a plus
Excellent written and verbal communication skills to explain insurance policy terms, clarify client queries, and coordinate with TPAs and insurance companies
High level of resilience to handle the pressure associated with managing a high volume of claims and client expectations
A proactive mindset with a focus on continuous improvement and delivering excellent service
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