Health & Legal Claims Specialist - Life Insurance

1 day ago

Mumbai, Maharashtra, India Weekday AI Full time ₹ 2,40,000 - ₹ 7,20,000 per year

This role is for one of Weekday's clients
Salary range: Rs Rs ie INR 4-6 LPA)
Min Experience: 4 years
Location: Mumbai
JobType: full-time

Requirements

We are seeking a meticulous and experienced Health & Legal Claims Specialist with a strong background in life insurance claims management. The ideal candidate will be responsible for managing and processing health-related claims, evaluating legal aspects of claims, ensuring compliance with insurance regulations, and maintaining high standards of customer service. This role requires a combination of analytical, legal, and risk management skills, with the ability to handle complex claims efficiently.

The specialist will work closely with underwriters, legal teams, healthcare providers, and clients to review, assess, and process claims while mitigating risks and ensuring timely settlements. The position demands strong attention to detail, knowledge of life insurance policies, and a proactive approach to resolving claims-related issues.

Key Responsibilities
  • Claims Assessment: Review and assess health-related and legal claims under life insurance policies to determine validity and adherence to policy terms.
  • Legal & Regulatory Compliance: Ensure that all claims processing aligns with applicable regulations, insurance guidelines, and company policies.
  • Documentation & Investigation: Collect, verify, and analyze medical records, policy documents, legal notices, and other supporting materials to facilitate claims evaluation.
  • Risk Mitigation: Identify potential fraudulent claims, discrepancies, or legal complications, and escalate cases to senior management or legal advisors as required.
  • Coordination & Liaison: Work closely with medical professionals, legal teams, insurers, and claimants to gather necessary information and facilitate smooth claim settlements.
  • Claims Processing & Settlement: Prepare detailed claim reports, recommendations, and approvals; ensure timely disbursement of valid claims.
  • Policy Interpretation: Interpret insurance policies and clauses to provide guidance on coverage, exclusions, and claims procedures.
  • Training & Advisory: Assist in educating internal teams and stakeholders about health claims processes, regulatory changes, and legal implications.
  • Customer Service: Provide clear communication to claimants, addressing queries, and maintaining high levels of customer satisfaction.
  • Reporting & Analytics: Maintain accurate records of claims, analyze trends, and generate periodic reports for management review and strategic decision-making.
Requirements & Qualifications
  • Bachelor's degree in Law, Life Sciences, Insurance, or related field; a Master's degree is a plus.
  • 4+ years of experience in life insurance claims handling, health claims, or legal claims management.
  • Strong understanding of life insurance policies, medical terminologies, and claims procedures.
  • Familiarity with regulatory frameworks governing health and life insurance claims.
  • Excellent analytical, investigative, and problem-solving skills.
  • Strong communication and negotiation skills to interact effectively with clients, legal authorities, and internal teams.
  • Proficiency in claims management software and MS Office tools.
  • Ability to work independently, manage multiple claims simultaneously, and meet strict deadlines.

  • Health Insurance Claims Manager

    7 days ago

    Mumbai, Maharashtra, India Grayquest Finance Full time ₹ 5,00,000 - ₹ 12,00,000 per year

    Job Description: Health Insurance Claims ManagerLocation: MumbaiExperience: 2-3 years in Health InsuranceEmployment Type: Full-timeJoining: ImmediateAbout GrayQuestGrayQuest is a rapidly growing FinTech company in the Indian education ecosystem. We specialize in providing EMIs for the $100B+ education market, offering zero-cost installments with insurance...

  • Legal Claims

    2 weeks ago

    Navi Mumbai, Maharashtra, India CMA Cgm Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    Role & responsibilitiesLegal Intern- Air and Ocean claims.Attending mandatory training programme comprising of in-class and on-floor sessions on topics including but not limited to Maritime laws, shipping contracts, and claims process. Handling cargo and container damage claims, air cargo, hull & machinery claims, indexing of claims and processing admin...

  • Legal Specialist

    3 days ago

    Mumbai, Maharashtra, India Liberty General Insurance Ltd Full time ₹ 6,00,000 - ₹ 12,00,000 per year

    Legal Specialist Description To be responsible for litigations (MACT Cases / Consumer Complaints / High Court Matters).Handle Motor Accident Claims Handle Employees Compensation Cases Handle Consumer Cases at various Forays constituted under Consumer Protection Act Handle Ombudsman Complaints Respond to Legal Notices Advising of other...

  • Senior Claims Specialist

    1 week ago

    Mumbai, Maharashtra, India Allianz Commercial Full time ₹ 12,00,000 - ₹ 36,00,000 per year

    Job Purpose / Role:The main purpose of this role is to proactively investigate, negotiate and resolve medium-sized claims, involving more complex issues and/or litigation. Ensure claims handled within authority limits, and in line with AGCS Claims Standards procedures and guidelines. Drive third party service providers to achieve economical results and to...

  • Claims Specialist

    4 days ago

    Mumbai, Maharashtra, India, Maharashtra GrayQuest Full time

    About GrayQuestGrayQuest is India’s leading FinTech innovator in the education ecosystem, transforming the$100B+ education industry through its cutting-edge financial solutions. Our flagship offering—monthly EMI solutions for school and college fee payments—makes education more accessible,affordable, and rewarding for millions of Indian families.We...

  • ate - CLAIMS SC

    2 weeks ago

    Mumbai, Maharashtra, India ICICI Prudential Life Insurance Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    Job DescriptionRetail Claims - Automation & ProjectsKey ResponsibilitiesAutomate Claims Processes- Design and develop automated workflows and business rules to streamline claims processing.Integrate with Existing Systems- Integrate automated claims processing solutions with existing systems and technologies.Testing and UAT - Test and validate automated...

  • Medical Billing/ Claims processing

    5 days ago

    Navi Mumbai, Maharashtra, India INTEGRUM OUTSOURCE SOLUTIONS PVT LTD Full time ₹ 2,40,000 - ₹ 4,80,000 per year

    Should possess U.S Health insurance claim processing experienceKnowledge of medical billing and coding terminologiesReady to work in Night Shift as well as Day shiftUnderstanding of plan documents and general benefitsFamiliarity with terms such as deductible, out of pocket, coinsurance, and copayStrong attention to detail and accuracyAbility to work in...

  • Health Insurance Agent

    2 weeks ago

    Mumbai, Maharashtra, India Aditya Birla Health Insurance Company Limited Full time ₹ 5,00,000 - ₹ 10,00,000 per year

    ***We're Hiring Health Insurance AdvisorsLooking for passionate, ambitious & people-friendly individuals from all industries & backgrounds who want: Unlimited earnings Flexible work hours Recognition & growth Chance to make a real difference in people's livesNo prior experience needed – we provide full training & mentorship.If you're motivated, educated,...

  • Freelance Health Insurance Consultant

    7 days ago

    Mumbai, Maharashtra, India Flexing It® Full time ₹ 2,50,000 - ₹ 7,50,000 per year

    Our client, a top tier management consulting firm, is looking for a professional with prior experience in the health insurance sector. The role will focus on claims management, underwriting processes, product design, and customer experience improvement in the health insurance ecosystem.Key Responsibilities:Support design, review, and enhancement of health...

  • Veterinary Doctor – Cattle Livestock Insurance Claims

    1 week ago

    Navi Mumbai, Maharashtra, India, Maharashtra Universal Sompo General Insurance Co. Ltd. Full time

    Job Title: Veterinary Doctor – Cattle Livestock Insurance ClaimsLocation: AiroliEmployment Type: Full-TimeDepartment: ClaimsJob Summary: We are looking for a qualified and experienced Veterinary Consultant to support the claims verification/assessment for losses reported under Cattle Livestock Insurance . The role involves conducting field investigations,...