Claims Executive

1 week ago

Indore, Madhya Pradesh, India ICICI Lombard Full time ₹ 4,00,000 - ₹ 8,00,000 per year

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.

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