86 Claim Investigation Jobs

Insurance Surveyor (IRDA Licensed) Experience: Minimum 5 years in Insurance company, Insurance Surveyor firm or Insurance Broker and having valid surveyor license from IRDA Requirements: Excellent communication skills in English & regional languages. Proficiency in MS Office, Internet and mobile apps. Good analytical skills. Flexible in learning and working in a pressure full environment. Core Responsibilities: Handling daily branch operations to ensure timely and proper survey reports. Manage and mentor back office staff. Ensure compliance with IRDA regulations and ethical standards. Coordinate with insurance companies and clients to maintain strong relationships and resolve disputes or escalations. Review and release survey reports. Monitor branch performance. Develop business strategies to grow the client base and improve service offerings. Handle budgeting and financial oversight for the branch including cost control and revenue tracking. Ensure quality control measures to maintain consistency and accuracy in survey assessments. Reporting: National leadership on branch performance, challenges and opportunities. Job Progression: The courses comprising Licentiate, Associate & Fellow conducted by Insurance Institute of India can be attended and cleared while working with the company. Also, the company provides compensation for passing these examinations including costs of books & examination fees as per company policy. Increments and promotions for outstanding performances as per company policy Interested one pls share your resume on recruiter4.spbcgroup@gmail.com or on 9315128588

Branch Manager Insurance Surveyor (IRDA Licensed) Experience: 5+ years in insurance company, surveyor firm, or broker with valid IRDA license. Skills: Insurance Survey, Claims Handling, IRDA Compliance, MS Office, Strong Communication (English + Regional), Leadership, Analytical Ability Key Responsibilities: Lead branch operations & timely survey reports Liaise with insurers & clients, resolve disputes Review & approve survey reports Mentor & manage back-office team Ensure compliance & quality control Drive business growth & monitor budgets Why Join Sponsored professional courses (Licentiate/Associate/Fellow) Performance-based rewards & promotions Step up your career with a reputed insurance surveyor firm! Interested one pls share your resume on recruiter4.spbcgroup@gmail.com or on 9315128588

Urgent requirement for BHMS,BAMS -Nagpur Freshers/candidate with clinical or TPA experience. Interested candidates can call on 9371762436 or share their updated resumes to career@mdindia.com Job Description: Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Need to Do field Visit Required Candidate profile: BHMS,BAMS graduate. both male and female can apply Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also apply. Work from office. Need to travel in Nagpur for filed investigation

Job Title: Motor Insurance Claims Handler (Bodily Injury Focus) Location: Bangalore Employment Type: Full-Time Department: Claims / Insurance Operations Reports To: Claims Team Lead / Claims Manager Job Summary: We are seeking a skilled and detail-oriented Motor Insurance Claims Handler with experience in bodily injury claims . The successful candidate will be responsible for managing and processing motor insurance claims efficiently and fairly, with a specific focus on bodily injury liability, third-party damages, and personal injury claims. This role requires strong analytical skills, empathy, and knowledge of motor insurance policies, local legislation, and medical terminology. Key Responsibilities: Handle and manage a portfolio of motor insurance claims, including bodily injury and third-party liability cases. Assess the validity of claims through careful investigation and policy review. Liaise with policyholders, third parties, medical providers, legal professionals, and law enforcement. Obtain and analyze medical reports, police reports, and other relevant documentation. Negotiate settlements in accordance with legal guidelines, policy terms, and internal procedures. Maintain accurate records of claim decisions and supporting documentation in the claims management system. Collaborate with legal and fraud teams where litigation or fraudulent activity is suspected. Keep up to date with changes in legislation and case law relevant to motor and injury claims. Ensure claims are processed within regulatory and internal timeframes. Deliver high-quality customer service during the claims lifecycle. Required Qualifications & Experience: Proven experience (1+ years) handling motor claims , specifically bodily injury or third-party personal injury . Familiarity with local insurance regulations and liability assessment. Experience working with medical terminology and understanding of injury classification. Knowledge of claims management systems and insurance software. Excellent verbal and written communication skills. Strong negotiation, analytical, and decision-making skills. Ability to manage multiple claims with attention to detail and urgency. Preferred Qualifications: Degree in Law, Insurance, Risk Management, or a related field. Insurance certifications. Experience with litigation claims or working with external legal counsel. Soft Skills: Empathy and tact when dealing with injured parties or sensitive situations. Integrity and professionalism. Resilience and ability to work under pressure. Collaborative mindset and team orientation. Contact Point : Deepanshu - 9900024811 / 9686682465 / 7259027282 / 7259027295 / 7760984460

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or deny the claims as per the terms and conditions within the TAT. Handle escalations and responding to mails accordingly. Work from Office only 1st Floor, H8M9+677, Block D, Noida Sector 3, Noida, Uttar Pradesh 201301 Interested candidates can share their resumes to WhatsApp to 9795919025

Review and interpret diagnostic and clinical reports Summarize patient findings in a standard reporting format for clients/insurance partners. Ensure accuracy and consistency in medical terminology and conclusions.

Job Description Acts as an interface between the TPA, Insurance Company and the hospital. Responsible for investigation of suspicious claims. Effective usage of Fraud control measures. Act as a backend support to the TPA. Responsible for data mining and analytics related to Fraud and Investigation (IFD) Field visit for investigation purpose. Client Servicing Responsible for developing the corporate customer base for MDIndia Health Insurance Services. Map the territory and maintain a strong pipeline of potential customers. Establish Contacts with key persons at the corporate and understand the current levels of Health Insurance services and needs. Develop strong relationship with Insurance Companies/Brokers. Promptly attending Emails, Phone calls, Whats App messages of Clients. Maintain proper MIS & Internal reports and present it to the management. Ability to work independently, achieve targets and be absolutely result oriented Open to travel. Desired Candidates Profile Qualification Any Graduate Experience Fresher - 2 Years Exp. Profile Executive Two wheeler is Mandatory If interested kindly share your resume to ta4@mdindia.com

Job Title: Insurance Desk Executive TPA Coordination / Claims Specialist Location Options: Cloudnine hospital Sarjapura branch (BLR) BBMP Khata No: 1907/Sy No: 26/1, 26, 2nd Main Rd, Kaikondrahalli, Haralur, Bengaluru, Karnataka 560035 - Sarjapur Cloudnine hospital Thanisandra branch (BLR) Address: Sy No: 86/2 and 86/3, Thanisandra Village, Thanisandra Main Rd, RK Hegde Nagar, Bengaluru, Karnataka 560077 Organization: Ayu Health Hospitals Experience Required: 02 years (Freshers are welcome to apply) Preferred Gender: Male Candidates Preferred Location: Candidates residing near hospital locations will be given preference About Ayu Health: Ayu Health is one of Indias fastest-growing healthcare networks, dedicated to making high-quality healthcare accessible and affordable for all. With a focus on technology-driven solutions, Ayu Health partners with reputed hospitals and clinics across the country to deliver standardized care, transparent pricing, and a seamless patient experience. We are on a mission to build Indias most trusted healthcare brand. Key Responsibilities: Handle insurance/TPA desk operations at the hospital premises Coordinate with TPA and insurance representatives for claim submission and follow-up Manage and organize patient insurance documentation accurately Track approvals, follow up on pending claims, and address rejections effectively Communicate professionally with patients, hospital staff, and insurance partners Support hospital administrative needs and maintain documentation records Multi-task and work collaboratively within the hospital environment Candidate Requirements: 02 years of experience in TPA coordination, insurance desk, or claims processing in hospitals (Freshers with good communication skills can apply) Strong interpersonal and communication skills Basic understanding of hospital processes is a plus Ability to manage documents and work efficiently under pressure Must be reliable, punctual, and a team player Preference will be given to candidates living nearby the hospital location Male Candidates only Immediate Joiners will be preferred

Role & responsibilities Contribute to renewal portfolio expansion through relationship building with the insurance companies and surveyors to ensure optimum claim settlement in the minimum time. During the processing of the claim analyze the following and communicate to underwriters: adequacy of coverage wrt. location specifications e.g.. Earthquake /flood etc. adequacy of the sum insured anomalies in the policy scope of additional policies other related information Control expenses Business Process Facilitate proper settlement of the claim in the shortest possible time to the satisfaction of the client by ensuring the following: Obtain complete information of loss from the client after initial intimation Submit intimation to the insurance company for Registration of claim, Allocation of surveyor. Follow up for deputation of surveyor In case of big losses, ensure Salasar representative accompanies the surveyor to understand the nature and extent of loss and give the client an indication of documents required. Intimate documents requirement for the client. Obtain LOR (List of requirements) from Surveyor Match LOR with Salasar's requirement already taken from the client and take the rest of the documents. Once documents are received, check exclusions in fine print and prepare the draft reply from the client submitted to the insurance company Follow up with a client for repair and reinstatement for early completion and help in documentation of estimate, contractor details, expenses, etc. so that the surveyor gets structured inputs for preparation of the survey report Follow up with surveyor for completion of assessment Communicate surveyor comments to the client in terms of estimate and exclusion and arrange a meeting between the surveyor and client to resolve differences to obtain client assessment Ensure surveyors report is submitted at the earliest Follow up with insurance company for early settlement of claim Obtain settlement voucher from insurance company and forward to client Get discharge of client (signoff) and submit to the insurance company for disbursement Update each step in SAIBA on real time basis and ensure due IRDA compliance Ensure resolution of all complex technical issues in claims and timely escalation of the same for quick disposal of the claim Customer Support the marketing department in obtaining new business and ensuring the best possible coverage for clients, talk to the technical dept of the client to understand which risks need to be covered, type of production (continuous/ batch) Reopen claims in case of new businesses and follow up to obtain claims after reopening of the file by the insurance company if the repudiation is not time-barred. Participate in fortnightly meetings to give updates to the business development and client servicing teams on the status of claims in order that they are updated about the same before meeting clients for renewals Interface with clients to reinforce relationships with existing clients Prepare and submit daily/monthly reports on the status of claims. People Growth Acquire product knowledge and always keep yourself updated with the latest variations in product offerings Attend training sessions (external/ internal) and work on on-job assignments to implement new learning Conduct training sessions for the marketing team as well as underwriting and claims teams to build product knowledge across functions Set objectives, review and evaluate performance periodically, and give feedback Review pending work and initiate action Perform all such duties which are required to be performed by this position in an insurance broking house in general course and to perform all such duties and carry out all such responsibilities so delegated or asked to be performed by the Designated Authority from time to time External Interface: Internal interface: Existing clients Prospective clients Insurance companies Surveyors Employees Preferred candidate profile a) Functional Competencies Demonstrates domain knowledge in own area of operation Understands product offerings Understands service standards as per Organisation ethos Learns continuously and keeps self-updated b ) Leadership Competencies: Relationship Building Networks effectively with both external and internal customers Focuses on building long-term sustainable relationships Delivers on commitment every time Creative & Analytical Problem Solving Understands the strategic objectives of the Organisation, unit, function Collates data and analyses them objectively Takes objective decisions based on data to achieve the strategic objective of the Organisation Goes the extra mile to achieve creative solutions Customer Focus Designs solutions that meet the requirements of the customer (external/ internal) Demonstrates a sense of urgency to resolve all external and internal customer concerns and responds to queries and requests within defined timelines and processes Educates customers (external/ internal) about changes in processes, policies, and offerings Creates long-term relationships with customers (external/ internal) through continuous interface Obtains customer (external/ internal) feedback to improve processes Promotes loyalty and converts customers to brand ambassadors Achieves customer delight with respect to both internal and external customers Is sensitive to code of conduct in office and customer establishments Perseverance Makes all possible efforts to understand the viewpoints of external and internal customers Takes all possible steps to resolve issues Understands the importance of deadlines, proactively removes roadblocks, and delivers as per requirement Tries alternatives to achieve the target Does not give up in the face of adversity Explains own point of view assertively to get necessary support and approval Is patient and persistent towards following up on all leads and prospects generated during the past towards new client acquisition Achievement Orientation Understands the strategic objectives of the Organisation, unit, function Aligns individual and team targets with strategic goals Plans and deploy appropriate resources to meet targets in the short and long term Goes the extra mile to achieve targets as per committed timelines and enable the team to do so Achieves and motivates excellence irrespective of circumstances Shares best practices across businesses Benchmarks with the best and continuously raises the bar Upgrades competencies of self and team to achieve excellence. Share your resume at susweta@salasarservices.com

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation Minimum Mandatory Skill Set : Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Desired Competencies/ Skill Set : MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, computer skills. Preferred Industry : Health Insurance, TPA, Hospitals, Healthcare

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation Minimum Mandatory Skill Set : Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Desired Competencies/ Skill Set : MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, computer skills. Preferred Industry : Health Insurance, TPA, Hospitals, Healthcare

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation Minimum Mandatory Skill Set : Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Desired Competencies/ Skill Set : MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, computer skills. Preferred Industry : Health Insurance, TPA, Hospitals, Healthcare

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com What would you do We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Claim processing team collects end-end data dataDevelop and deliver business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for Communication SkillsTeamwork & CollaborationProblem-Solving & Critical ThinkingAdaptability & Willingness to LearnTime Management & Organization Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or deny the claims as per the terms and conditions within the TAT. Handle escalations and responding to mails accordingly. Work from Office only Pune address: C-Wing, First Floor, Manikchand Icon, Balkrishna Sakharam Dhole Patil Rd, Sangamvadi, Pune, Maharashtra 411001 Mumbai address: 4th floor, AARPEE Chambers, Off Andheri-Kurla Road Industrail Estate Marol, Andheri East, , Marol Cooperative Next To Times Square, Shagbaug, Gamdevi, Marol, Mumbai, Maharashtra 400059 Interested candidates can share their resumes to WhatsApp to 9632777628

As a Claims Officer, your primary responsibility will be to efficiently handle and process insurance claims. You will be tasked with receiving and registering claims from policyholders or their representatives in a timely and professional manner. This includes collecting all necessary claim forms and documents to initiate the process. In addition, you will be required to meticulously collect and verify information related to the claims. This may involve gathering supplementary documents such as police reports, medical records, and any other relevant information essential for a thorough assessment of the claim. A crucial aspect of your role will be conducting detailed investigations into the circumstances surrounding each claim. By meticulously examining the facts, you will determine the eligibility of the claim, evaluate the extent of the loss, and identify any potential red flags that may require further scrutiny. Furthermore, you will be responsible for negotiating with policyholders and adjusters to reach fair and accurate settlements. Your communication skills will be essential as you interact with various stakeholders to provide updates on the status of claims and address any queries or concerns that may arise. Ensuring transparency and professionalism, you will maintain accurate and comprehensive records of all claims processed. This documentation is vital for tracking the progress of claims and for compliance purposes. This is a full-time position with benefits including health insurance, a yearly bonus, and a day shift schedule. The work location is in-person, and the expected start date is 22/07/2025. If you are interested in this opportunity, please contact the employer at +91 7510400320. The application deadline is 16/07/2025.,

To lead and manage the claims operations by ensuring timely, fair, and compliant claim settlements, optimizing processes for efficiency, and supporting strategic goals through data-driven decision-making and cross-functional collaboration Ensure timely and accurate settlement of claims within defined turnaround times (TATs) Maintain adherence to IRDAI regulations and internal claims policies Identify and mitigate fraudulent claims through effective investigation and controls Enhance claimant experience through transparent communication and service excellence Lead, mentor, and upskill the claims team to improve performance and accountability Optimize claim payouts and reduce leakage through data-driven decision-making Collaborate with cross functional teams for complex claim resolutions Timely and accurate claim settlements to avoid interest penalties Detection and prevention of fraudulent claims to reduce financial loss Accurate payout calculations aligned with policy terms Reduction in claim rework or overpayments Minimal customer complaints or escalations Timely and empathetic communication with beneficiaries Clear guidance provided throughout the claim process Claims processed within defined turnaround time (TAT) 100% compliance with regulatory and internal audit standard Effective coordination with legal and other departments Accurate and complete documentation for each claim Contributions to process improvement initiatives

Hiring Clinical Doctors for Medical coding role in Mohali !! Job Location - Mohali Role : Auditor I (IPDRG) Eligibility Criteria: Education BHMS,BAMS,MBBS,BPT Candidates with prior US Healthcare or Clinical experience will be preferred. Fresher Physicians can also apply with good clinical knowledge. Noncertified Physicians can apply however should be ready to complete the same within specified timeline. (CIC) Good communication skills. Candidates with corporate experience will be preferred. Immediate joiners preferred. Should be ready to work from office. Should be ready to work in night shift. Interested candidates can share resume - abdul.rahuman@cotiviti.com Regards, Abdul Rahuman 9080276094

We are seeking a dynamic and detail-oriented Insurance Professional for the Legal Department to manage end-to-end insurance policy administration, claims processing, and risk management across multiple sites. The ideal candidate will have experience in insurance handling, preferably in the solar sector, and the ability to manage and coordinate across teams and insurance partners. COMPENSATION & BENEFITS: Medical Insurance Performance Incentives Cool Work Environment Travel Reimbursement (as per company policy) Exposure to challenging legal and insurance portfolios Supportive team and professional development ABOUT SADBHAV FUTURETECH LIMITED: Company Size - ~100 employees Headquarters - Gurgaon, Haryana Company Turnover - 300-350 Cr. Founded Since - Year 2020 Sadbhav Futuretech is committed to providing comprehensive and end to end solutions for farmers across India. Sadbhav addresses the major challenges of farmers through its three service verticals while ensuring value creation for all stakeholders. Our endeavor is to establish Sadbhav Futuretech as Indias first choice for solar project execution, co-operative farming, and cold chain management. We project to become the largest aggregator of farmers in India over the next 5 years. VISION: To be the largest Renewable and Agri-Tech based platform in the country impacting the lives of more than 1 million farmers over the next 10 years. OUR SPECIALITIES: Solar Agricultural Pumps, PM KUSUM Scheme, Kusum Component C, Kusum Component B, FaaS - Farming as a Service, Empowering Farmers, Solar Rooftop Solutions, Solar EPC, Solar Ground Mounted, Solar Rooftop, and Solar Solutions JOB RESPONSIBILITY: Manage complete insurance policy lifecycle, including issuance, renewals, and cancellations for company assets and projects Handle insurance claims for assets, equipment, and warehouse-related incidents Coordinate with internal stakeholders and insurance service providers for smooth claims resolution Ensure timely documentation and submission of all claims and follow-ups until settlement Analyze claim trends and risk exposure and recommend strategies for risk mitigation Maintain updated insurance-related records and compliance documentation Assist in risk assessments and inspections at warehouses and project sites Generate periodic reports and MIS on insurance coverage, claims status, and premium schedules Support internal legal compliance initiatives related to insurance law and statutory obligations DESIRED PROFILE: Minimum 3 to 4 years of experience in insurance handling and claim settlements Must hold a Diploma in Insurance or equivalent certification Experience in the solar sector or renewable energy is preferred Willingness to travel across India (30% to 40%) for on-site inspections and audits Proficient in Hindi and English (spoken and written) Strong coordination and analytical skills DESIRED SKILLS: Knowledge of general & property insurance policies (fire, asset, liability, etc.) Excellent written and verbal communication Hands-on experience in claims documentation and settlement Sound understanding of insurance laws, contracts, and coverage terms Proficient in MS Excel, Word, and reporting tools Strong negotiation and relationship management skills WHY JOIN US? • Work with a fast-growing leader in renewable energy • Be part of an organization making a sustainable impact across India • Dynamic and inclusive work culture • Opportunity to lead key insurance and legal operations independently PREFERENCE: Corporate Office; Unicorn Start-Up; Young Energetic Person

Prepare ILAs, Final Survey Reports, and requirement letters. Maintain records of claim intimation, surveyor visits, document status, and report. Follow up with insured and internal teams to minimize TAT Update data in CMS software Health insurance Provident fund

Job Summary We are seeking a highly skilled and experienced Team Lead for our RTR-Reinsurance domain. The ideal candidate will have 7 to 10 years of experience in customer service within the insurance domain. The role requires a strong understanding of claim investigation and property & casualty insurance. This is a hybrid work model with rotational shifts. Responsibilities Lead a team of customer service representatives in the P&C division to ensure high-quality service delivery. Oversee daily operations and ensure adherence to company policies and procedures. Provide guidance and support to team members to resolve complex customer issues. Monitor team performance and implement strategies to improve efficiency and effectiveness. Collaborate with other departments to ensure seamless service delivery and customer satisfaction. Conduct regular training sessions to keep the team updated on industry trends and best practices. Analyze customer feedback and develop action plans to address areas of improvement. Ensure compliance with regulatory requirements and company standards. Prepare and present regular reports on team performance and customer satisfaction metrics. Participate in the development and implementation of new processes and systems to enhance service delivery. Foster a positive and collaborative team environment to achieve common goals. Utilize domain expertise in claim investigation and property & casualty insurance to provide exceptional service. Adapt to rotational shifts and hybrid work model to meet business needs. Qualifications Possess a minimum of 7 years of experience in customer service within the insurance domain. Demonstrate expertise in claim investigation and property & casualty insurance. Exhibit strong leadership and team management skills. Show proficiency in analyzing data and developing actionable insights. Have excellent communication and interpersonal skills. Display the ability to work in a fast-paced and dynamic environment. Be adaptable to rotational shifts and hybrid work model. Possess a strong understanding of regulatory requirements and industry standards. Demonstrate a commitment to continuous learning and professional development. Show the ability to collaborate effectively with cross-functional teams. Exhibit problem-solving skills and the ability to handle complex customer issues. Have experience in preparing and presenting performance reports. Be proactive in identifying areas for improvement and implementing solutions. Skillset Ceded/Assumed premium/Commission, Quota share, has experience with Bordereau etc

Responsible for overseeing and managing the claims process and ensures all claims are handled efficiently. Act as the main point of contact for customer inquiries,work to resolve issues promptly and Prepare regular reports on claims status.

POSITION: MEDICAL OFFICER/CONSULTANT PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Mumbai Educational Qualification Shift BHMS, , BAMS, MBBS(Indian registration Required) Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. • • • Responsibilities Understand the process difference between PA and an RI claim and verify the necessary details accordingly. • Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff. • • Approve or deny the claims as per the terms and conditions within the TAT. • Handle escalations and responding to mails accordingly. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies

Description: JD for Investigations Manager, Claims Job Position Manager, Investigation - Claims based out of Corporate Office, Mumbai Job Brief Manager to oversee investigations for claims (Legal-TP Claims/ WC claims/ OD claims, PA Claims, Theft Claims & Health Claims, Commercial claims) of our GI business. The successful candidate will effectively ensure investigation conformity and minimize probability of exposure Academic Qualification Must be a graduate from a recognized institution or university. Law Graduate (LLB or LLM) + III pass out will be the first choice Required Experience / Key responsibilities Candidate must be experienced with 5 to 7 yrs in General Insurance Industry - specially in claims investigation field Experience in handling team (minimum 02 member) with minimum exposure of Zonal portfolio Exposure in dealing with MACT / Third Party Claims & WC matters, PA claims, Health claims, OD claims & Theft Claims investigation Candidate must have good drafting skills as well as communication skills Candidate must have well experience in recovery procedure (Pay & Recovery Legal Claims & Theft vehicle recovery) Experience in handling for & against litigations before various courts arising out of claims (civil, criminal etc..) Candidate should have well conversant about latest laws pertaining to Insurance Laws, Criminal law & Indian Evidence Act Experience in handling Advocates & Investigators : (1) Vetting of relevant applications whenever requires in best interest of the company (2) review of investigation report to conclude/ quantify cases into respective categories (settleable/contest/defence) Must be conversant with MS office for day-to-day activities & maintaining required MIS to extract important/effective details Experience in adducing evidence to defend the matters rigorously & to safeguard company's interest whenever required Experience in handling Criminal proceedings before Police authority or action required before RTO authority or subsequent authority whenever required

Role & responsibilities Graduate Medical background, MR (B pharma), BHMS, BAMS/ MBA in Hospital Adminstration 2+ Years working experience in health insurance/health insurance TPA at Hospital handling/audit Candidate must have excellent knowledge of health insurance / Health TPA domain. Candidate must have excellent bill/medical negotiation skills & customer handling skills. Good communication skills in Hindi/English and regional language of the state/region. Ready to relocate himself/herself at location within India as may be required according to the job requirement Candidate must own vehicle to travel in various hospital assigned to him Candidate must be computer literate and shall possess skills including but not limited to Microsoft Office Suite and navigating through internet Portals Candidate will be mapped with minimum 20 hospitals for physical visit based on the location and city. Additionally 20-25 Hospitals for Case Audit and Management Proficient in handling complex situations and customers. Candidate must possess clinical knowledge for evaluation of medical files Sound knowledge of surgical procedures and disease cure management Preferred candidate profile

Job Description Acts as an interface between the TPA, Insurance Company and the hospital. Responsible for investigation of suspicious claims. Effective usage of Fraud control measures. Act as a backend support to the TPA. Responsible for data mining and analytics related to Fraud and Investigation (IFD) Field visit for investigation purpose. Open to travel. Desired Candidates Profile Qualification Any Graduate Experience Fresher - 2 Years Exp. Profile Executive If interested kindly share your resume to recruitment1@mdindia.com