Claims Executive

17 hours ago

Bengaluru Pune, India Digit Insurance Full time ₹ 1,04,000 - ₹ 1,30,878 per year
  • Process and review Life insurance claims, ensuring adherence to company policies and guidelines.
  • Verify claim documentation, including Death certificate , Employment details, medical records to rule out cause of death and co-morbidities, PMR, FIR , and other supporting documents.
  • Examine insurance applications and documents to ensure accuracy.
  • Communicate with claimants to obtain necessary information and explain the claim process.
  • Assess the validity and coverage of claims, determining eligibility for reimbursement or settlement.
  • Collaborate with claimants, insurance agents, and medical professionals to gather necessary information and resolve any claim-related queries or issues.
  • Keep claim files organized, documenting all actions and decisions.
  • Decision-Making: Determine claim payouts by verifying coverage and assessing the insurance policy.
  • Collaborate with internal teams, such as underwriters and legal departments, to evaluate complex claims and ensure compliance with regulatory requirements.
  • Keep up-to-date with insurance industry trends, policies, and regulations related to Life insurance claims.

Requirements:

  • DOCTORS Preferable. Degree in BMS/BAHMS/MBBS, etc (medical background)
  • Previous experience in Life claims processing or a similar role within the insurance industry.
  • In-depth knowledge of insurance principles, policies, and procedures, specifically related to Life Term insurance.
  • Strong understanding of Life claim processing and settlement methodologies.
  • Excellent analytical and problem-solving skills, with the ability to make sound decisions regarding claim eligibility and coverage.

    Attention to detail and accuracy in reviewing and processing claim documentation.
  • Exceptional communication skills to interact effectively with claimants, insurance agents, and internal stakeholders.

    Proficient in using relevant software applications and tools for claim processing and record-keeping.
  • Ability to work independently, manage multiple tasks, and prioritize workload effectively.
  • Familiarity with regulatory guidelines and compliance requirements related to Life insurance claims.

In addition to the above requirements, as an executive-level profile, the ideal candidate should also possess:

  • Leadership skills to oversee and mentor a team of claims processors. Proven experience in managing and optimizing claims processing workflows.
  • Strong problem-solving and decision-making abilities, particularly in complex or high-value claim scenarios.
  • Excellent interpersonal skills to collaborate with senior management, stakeholders, and external partners.
  • Demonstrated ability to analyse data, generate reports, and present findings to senior executives.
  • Knowledge of strategic planning and business development concepts within the insurance industry.

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