Officer Claims

· Evaluate medical claims including both out-patient claims and In-Hospitalization Claims under the policy terms and conditions and recommend claims for approval

· Handle claims from receipt of notification to settlement and take into consideration opinions of the outside Doctor's regarding the claims

· Correspond with clients and agents/Investigator regarding claim queries

· Coordinate with Accounts Department regarding claims payments

· Telephonic/Outdoor investigation of facts involved in claims.

· Monitor team reports, direct necessary action, and inform head of department regarding pertinent information

· Prepare the Service Quality complaint log, handle Service Quality projects and maintain claims TAT

· Participate in assigned claims projects as and when required

Qualifications/ Experience/ Capabilities

· Minimum level of Education for this job: Bachelors (medical related field preferred)

· Minimum Experience required for this job: 2 years (preferably in health claims of an insurance company)