Team Member - Claims

Job Overview

This role involves expertise in claims processing including indemnity claims such as cashless and reimbursement, as well as handling fixed benefit products. The candidate will be expected to manage and monitor claims operations effectively with a focus on maintaining quality and turnaround times.

Key Responsibilities

• Possess thorough understanding of claims handling processes including indemnity claims (cashless and reimbursement) and fixed benefit insurance products.
• Familiarity with claims system workflows and data fields specific to Health, Personal Accident (PA), and Travel insurance domains.
• Monitor and measure performance metrics such as turnaround time (TAT) and accuracy in claims adjudication.
• Manage the expectations and performance standards of the claims team to ensure consistency and compliance.
• Handle specialized business claims with strict adherence to TAT and set expectations.
• Maintain uniform quality standards and uphold the turnaround times for claims decisions.
• Develop and enforce standard protocols and operational procedures for the claims unit.
• Conduct audits of claims decisions to ensure adherence to guidelines, consistency in approvals, and compliance with defined approval authority limits for both in-house and third-party administrator (TPA) claims.