Claims Associate

Responsibilities:

• 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 analyze data, generate reports, and present findings to senior executives.
• Knowledge of strategic planning and business development concepts within the insurance industry.