Assistant Manager - Insurance Claims (5-8 yrs)

Job Title: Assistant Manager - Insurance Claims

Location: Gurgaon

Industry: Insurance / Broking

Experience: 5 to 8 years

Qualification: Graduate and above

Job Summary:

The Assistant Manager - Insurance Claims will play a crucial role in managing and processing insurance claims related to Group Medical Cover (GMC), Group Personal Accident (GPA), Group Term Life Insurance (GTLI), and Workmen Compensation (WC) policies. The ideal candidate will have strong technical knowledge of insurance claims processes and be adept at managing relationships with clients, Third-Party Administrators (TPAs), and insurance companies to ensure smooth and efficient claim settlements.

Key Responsibilities:

Claims Management:

- Maintain updated Claim MIS for all clients on a weekly basis.

- Keep track of the Claims Master File for all reported claims, ensuring all information is accurate and updated.

- Assess claim documents before forwarding to TPAs or insurance companies to ensure they are complete and meet the insurer's requirements.

- Follow up with TPAs/Insurance companies to ensure claims are processed within the agreed TAT (Turnaround Time).

- Verify and share E-cards and physical cards for all endorsements and renewals.

Claim Processing:

- Conduct a basic assessment of claim admissibility before submission.

- Share monthly claims MIS with clients, providing them with an updated overview of claim status and settlements.

- Send approval letters/settlement UTRs (Unique Transaction Reference) to clients for reimbursement claims.

Client Relations and Support:

- Serve as a point of contact for clients during claims, providing clarifications on policy terms and conditions.

- Build and maintain strong relationships with clients and TPAs to facilitate smooth claims processing.

- Present and explain policy terms to clients during renewal discussions, providing valuable insights and recommendations on value additions.

Policy Management:

- Maintain copies of policy documents and ensure clients receive their policy-related information in a timely manner.

- Make presentations on policy terms and clarifications during policy renewals.

Improvement and Reporting:

- Provide inputs on process improvements and value-added services for the claims team.

- Identify areas for improvement in the claims process and propose solutions for enhancing efficiency and client satisfaction.

Technical Skills Required:

Insurance Knowledge:

- Professional expertise in processing GMC (Group Medical Cover), GPA (Group Personal Accident), GTLI (Group Term Life Insurance), and WC (Workmen Compensation) claims.

- Strong understanding of Employee Benefit (EB) claims processes across various insurers and TPAs.

- Basic understanding of claim admissibility and assessment procedures.

Computer Proficiency:

- Proficient in MS Excel, Outlook, and the Internet for managing claim-related data and documentation.

- Ability to prepare and maintain complex MIS reports with accuracy and attention to detail.

- Familiarity with insurance claims software and tools used for policy and claims management is a plus.

Soft Skills Required:

Communication:

- Excellent written and verbal communication skills to explain insurance policy terms, clarify client queries, and coordinate with TPAs and insurance companies.

- Ability to prepare and deliver presentations to clients, especially during policy renewals and claims review meetings.

Relationship Management:

- Strong interpersonal skills to maintain good relationships with clients, TPAs, insurance companies, and other stakeholders.

- Proactive in engaging with clients to address concerns, resolve issues, and provide updates.

Analytical Skills:

- Strong attention to detail in assessing and processing claims, ensuring accuracy in claims reporting, and identifying discrepancies.

Time Management:

- Ability to manage multiple claims simultaneously, ensuring timely follow-ups and meeting deadlines.

- Adept at prioritizing tasks and managing time efficiently to handle large volumes of claims.

Problem-Solving:

- Capable of identifying barriers or issues in claims processing and proposing effective solutions to ensure claims are processed smoothly.

Desired Profile:

Personality Traits:

- Smart, aggressive, and driven to meet organizational objectives while maintaining excellent client satisfaction.

- High level of resilience to handle the pressure associated with managing a high volume of claims and client expectations.

- A proactive mindset with a focus on continuous improvement and delivering excellent service.