Primary Role Description:
- The job holder will be responsible for providing dedicated claims facilitation and resolution support in high-business volume branches.
- The primary focus is to provide end to end assistance for claims service to channel partners, sales team and claimants throughout the claims lifecycle.
- The role encompasses end-to-end claims coordination, including documentation guidance, status tracking and grievance management.
- The incumbent will act as a critical bridge between different stakeholders and the central claims team to proactively resolve processing bottlenecks, expedite settlements, and ensure a seamless, transparent experience from submission to resolution.
Key Roles & Responsibilities:
- Claims Facilitation & Escalation: Act as a bridge between the sales team, partners, and the central claims team to expedite the processing of pending claims and resolve bottlenecks.
- Elite Partner & Customer Support: Provide dedicated support to CEO/CDO/National Head Club agents and customers regarding claim status updates,
documentation requirements, and grievance handling.
- Claims Documentation & Verification: Ensure all claim documents, medical records, and KYC/AML checks are uploaded, indexed, and verified with 100% accuracy before submission to the central team.
- Regulatory & Audit Compliance: Maintain strict adherence to internal and regulatory guidelines for claim reporting and data privacy.
Key Performance Indicator (KPI)
- Query Resolution: Significant reduction in pending claim queries and TAT for claim settlement.
- Service Excellence: Achievement of target CSAT/NPS scores specific to the claims experience.
- FTR (First Time Right): >98% accuracy in claim document collection to prevent rejections or delays.
- Audit Compliance: Zero critical errors in claim document indexing and regulatory reporting.
Key Requirements – Education & Certificates:
- Must be a medical graduate i.e BDS, BPT, BHMS, BAMS, BUMS, etc