Executive - Claims Job

Key responsibilities:

1. Manage the end-to-end process of health/accidental/life insurance claims through the insurance company/TPA
2. Provide excellent customer service to policyholders and healthcare providers by addressing queries, concerns, and escalations related to claims
3. Maintain a professional and empathetic approach when handling sensitive and challenging customer interactions
4. Build and maintain strong relationships with insurance providers, healthcare professionals, and internal stakeholders to streamline communication and collaboration
5. Coordinate with these parties to resolve complex or disputed claims efficiently
6. Utilize strong analytical and problem-solving skills to assess complex claims and make accurate decisions
7. Manage and resolve issues or concerns that arise within the insurance policy or claims process. It involves a systematic approach to address and resolve problems, ensuring that they are effectively managed and escalated to the appropriate individuals or departments for resolution
8. Implement quality assurance measures to ensure the accuracy and consistency of claims processed by the insurance company/TPA
9. Conduct regular audits and reviews to identify areas for improvement and implement corrective actions
10. Ensure proactive outreach to the clients and stakeholders
11. Work on other day-to-day operational services like work allocation, report preparation, etc.

Requirements:

1. In-depth knowledge of health insurance policies, claim procedures, and regulations; familiarity with policy terms
2. Ability to handle confidential information and maintain data privacy and security
3. Willingness and flexibility to take customer calls beyond office hours including week-off and holidays

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