Clamis executive employee benifit

3 days ago

Pune, Maharashtra, India Accurate Risk managers and Insurance Brokers Full time

Company Description

Accurate is a premier Insurance Consulting and Risk Advisory firm, widely recognized as a leading Employee Benefits Consultant within the insurance sector. We deliver comprehensive solutions across Risk Management, Risk Mitigation, and Insurance Placement to meet the complex, evolving needs of our clients. Our services span the entire insurance lifecycle, from strategic advisory and program design to implementation, ongoing management, and optimization. We are committed to excellence, ensuring clients receive customized risk solutions and value-driven insights that enhance operational resilience and support long-term business objectives.

Role Description

Claims Executive – Death & Hospitalisation (Employee Benefits / Health / Life)

Key Responsibilities:

Claims Intimation & Registration

Receive and register hospitalisation or death claims from clients, HR departments, or insured members.

Validate the claim intimation details and supporting documents before forwarding to the insurer or TPA.

Create and maintain claim tracking logs for each case.

Review claim documents such as discharge summaries, hospital bills, death certificates, FIR/post-mortem reports (if applicable), and policy documents.

Ensure completeness and correctness of claim files before submission.

Follow up with clients or TPAs for missing or additional information.

Liaise with insurance companies and TPAs for claim registration, processing, and settlement updates.

Escalate delayed or disputed claims and assist in resolving issues through negotiation and clarification.

Support claim approvals within agreed timelines.

10.  Track and monitor the status of all open claims.

11.  Prepare claim MIS and analysis reports for clients and management (e.g., claim ratio, turnaround time, settlement trends).

12.  Highlight claim patterns or problem areas that may affect renewal or risk assessment.

13.  Act as a single point of contact for clients (corporate HR or individual customers) regarding claim status and documentation.

14.  Provide clear communication on claim requirements, process steps, and timelines.

15.  Assist families sensitively and professionally in case of death claims.

16.  Ensure adherence to IRDAI regulations and company SOPs.

17.  Maintain digital and physical claim records in an organized and confidential manner.

18.  Support internal and external audits with proper documentation.

Key Skills & Competencies:

Strong knowledge of health, life, and group insurance claim processes.

Excellent communication and empathy when handling sensitive death or hospitalisation cases.

Analytical and documentation skills.

Proficiency in MS Excel and claim tracking systems.

Ability to coordinate with multiple stakeholders (clients, insurers, TPAs).

Qualifications & Experience:

Graduate / Postgraduate in Insurance, Commerce, or related field.

–5 years of experience in claims handling (preferably in insurance broking, TPA, or insurer).

Familiarity with IRDAI claim guidelines and insurer claim portals.

Performance Indicators (KPIs):

Claim turnaround time (TAT) and accuracy of documentation.

Claim settlement ratio and client satisfaction scores.

Compliance with claim handling and reporting standards.

Responsiveness and resolution rate of escalated claims.

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