1 Claims Processing Adjudication Evaluate and process medical health insurance claims per policy terms SOPs and TAT quality benchmarks Scrutinize medical records invoices and reports to determine claim admissibility and payable amount Validate coverage exclusions sub-limits and waiting periods against policy documents Authorize and post claim payments in the system 2 Documentation Accuracy Compliance Ensure all claim files are complete accurate and compliant with IRDAI guidelines and internal policies Maintain production and quality standards participate in QC reviews and corrective actions Prepare and update claim notes summaries and system entries with zero data discrepancies 3 Customer Communication Handle inbound outbound calls and emails to explain policy T Cs claim decisions and required documents Provide timely status updates and resolve customer queries professionally 4 Fraud Detection Investigation Flag suspicious patterns inconsistencies or potential fraud escalate for investigation as needed Conduct basic fact-finding doctor hospital verification additional document requests to support validity checks 5 Issue Resolution Coordination Resolve mismatches billing errors and document gaps by liaising with hospitals TPAs and internal teams Coordinate with finance for payment re-issues reversals or recoveries when required 6 Cross-Training Continuous Improvement Adapt to multiple product lines processes support peers during peak loads Suggest process improvements to enhance TAT accuracy and customer experience Participate in refresher trainings and keep abreast of regulatory updates 7 Reporting Record Keeping Track and report daily productivity pending queues and exceptions to the team lead manager Maintain secure records and ensure confidentiality of customer data at all times APPLY NOW btwgroup co careers Job Types Full time Fresher Pay 15 550 00 - 18 500 00 per month Work Location In person Speak with the employer 91 (phone hidden)

📌 Claims Executive – Health Insurance (Maharashtra)
🏢 Important Group
📍 Maharashtra