Handle the complete claims settlement process from claim registration to final settlement.
Review and verify claim documents for accuracy and completeness.
Coordinate with customers, hospitals, insurance companies, and third-party administrators (TPAs) for claim processing.
Follow up on pending documents and resolve claim-related queries.
Assess claim eligibility as per policy terms and conditions.
Process cashless and reimbursement claims within defined turnaround times (TAT).
Maintain accurate claim records and update claim management systems.
Ensure compliance with regulatory requirements and internal policies.
Investigate discrepancies and escalate complex cases when required.
Prepare claim status reports and maintain operational MIS.
Provide prompt and professional customer support throughout the claims lifecycle.
Support process improvement initiatives to enhance operational efficiency