Claims Executive

4 days ago

Powai Mumbai Maharashtra, India SM Group Full time

**Experience**: Minimum 2 Years

**Salary**:up to 3.5 LPA

**Reporting to**: Megha N Sr Claims Executive

**Working Hours**:10:00 AM 6:30 PM (Two Saturdays off per month)

**Employment Type**:Full time

**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**:

- Visit hospitals to support HNI clients during cashless claims.
- Handle claims processing in the absence of other team members.

**Qualifications**
- Graduate (Preferred Insurance, Healthcare, or Business-related field).
- Minimum Experience 2 years in insurance claims processing.
- In depth knowledge of **insurance policies, TPAs, claim life cycles,** and **regulatory compliance.**

**Key Skills**:

- Excellent verbal and written **communication skills in English.**
- High level of **accuracy and attention to detail.**
- Strong **time management and organizational skills.**
- Ability to work both **independently and in a team.**
- **Customer centric** approach with a proactive problem-solving attitude.
- Proficiency in using **Microsoft Office tools** (Word, Outlook).
- Good understanding of **insurance claim cycles,**documentation standards, and regulatory norms.

**Compensation Benefits**:

- Competitive salary package in line with **market standards,**
- **Group Medical Insurance** (GMC) coverage,
- Annual performance-based increment eligibility,

**Application Process**

For queries, contact **+91 8850694865**

**Job Types**: Full-time, Permanent

Pay: ₹10,041.93 - ₹34,666.29 per month

**Benefits**:

- Health insurance

Schedule:

- Day shift

Supplemental Pay:

- Performance bonus

Work Location: In person

**Speak with the employer**
+91 08850694865

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