Job Summary

We are hiring a Health Claims Executive (Broker-Side) to manage end-to-end health insurance claims for our retail and corporate customers. The role is desk-based and customer-facing you will guide customers through cashless and reimbursement claims, coordinate with insurers and TPAs, and ensure claims are settled accurately and on time.

This role is strictly for candidates with prior health claims experience at a General Insurance Broker or TPA. Immediate joiners preferred.

Key Responsibilities

- Manage the full health claims lifecycle: cashless (pre-auth to approval) and reimbursement claims
- Process OPD claims — doctor's consultation, pharmacy, and diagnostic/investigation reimbursements
- Handle Personal Accident and Travel claims where required
- Interact directly with customers to explain claim status, documentation gaps, deductions, and settlement timelines
- Coordinate with insurer and TPA claims teams to expedite approvals and resolve queries/rejections
- Scrutinise claim documents for completeness and accuracy before submission to reduce query loops and deductions
- Track claims to closure and follow up on delayed settlements and short payments




- Support renewal servicing by keeping claims history and customer records clean

Mandatory Experience & Skills (Non-Negotiable)

- Minimum 3 years in health claims at a General Insurance Broker or TPA (Mumbai-based experience preferred)
- Hands-on experience with cashless and reimbursement claims processing
- Working knowledge of OPD claim reimbursement
- Familiarity with insurer and TPA portals and claim documentation standards
- Strong communication and customer-handling skills; ability to explain deductions and rejections clearly
- Personal Accident and Travel claims experience will be a strong advantage

Qualification

- Graduate in any discipline
- Insurance certifications (IRDAI / III) preferred

What We Offer

- Direct exposure to a multi-line book and robust insurer relationships built over decades
- A Firm where claims servicing is treated as core, not an afterthought
- Long-term growth in a third-generation, established Mumbai

How to Apply Email your resume to: [email protected]

Subject: Application – Health Claims Executive (GI)

📌 Health Claims / Health Service Executive (General Insurance) (Mumbai)
🏢 Fortune 5 Risk Management Solutions
📍 Mumbai