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 prospects and manage multiple claim-related activities.
Perform other claim-related tasks as required.

Required Skills & Competencies
Valuable 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