Role Overview

We are looking for a Claim Handler - OPD Claims, responsible for reviewing, evaluating, and processing insurance claims as per company policies and regulatory guidelines. The role involves medical document review, claim assessment, customer coordination, and claim-related calling while ensuring accuracy, quality, and timely resolution.

Key Responsibilities
- Evaluate, review, and process claims in accordance with company policies, procedures, productivity, and quality standards.
- Examine medical documents and assess claim admissibility based on policy terms and conditions.
- Review medical claims and verify information for accuracy and completeness.
- Coordinate with customers over calls to explain policy terms & conditions, claim details, claim status, and documentation requirements.
- Handle customer queries related to claims and provide timely updates/resolutions.
- Deliver excellent customer service by addressing policyholder concerns professionally.
- Identify discrepancies in claims and coordinate for corrections or additional information.




- Examine claims for potential fraud indicators and conduct investigations wherever required.
- Gather additional information/documents to determine the validity of claims.
- Ensure compliance with company policies, processes, and regulatory requirements.
- Maintain productivity and quality standards as per defined expectations.
- Process claim payments accurately as per approvals and guidelines.
- Adapt to cross-training opportunities and manage multiple claim-related activities.
- Perform other claim-related tasks as required.

Required Skills & Competencies
- Good communication skills in English and Hindi (mandatory).
- Comfortable with customer coordination and customer calling.
- Strong customer service skills.
- Valuable medical knowledge and understanding of medical terminology.
- Basic understanding of insurance claims process (preferred).
- Basic knowledge of IRDAI guidelines will be an added advantage.

📌 Sr. Associate (Bengaluru)
🏢 Acko
📍 Bengaluru