EB Claims Executive

Job description
✨ We have a vision of making insurance accessible to all.
Insurance empowers people and companies to take risks while protecting their assets and liabilities. We believe that the insurance sector in India is still in its infancy owning to the low penetrations in Tier-III cities and rural India. We accelerate awareness about the advantages of insurance products among clients to service and enhance the scope of the benefits of insurance to all customers reliably. In this course, we also aim to create self-employment for thousands of youths in rural India by enabling them to sell insurance ethically.
💭 Why?
Because technology is a nascent part of insurance industry but will define its future and enable all buyers to make better choices remotely with just a few taps. Harnessing technology will facilitate PrishaPolicy to service our clients better and create an atmosphere where insurance is delivered with ease.
🕵🏻Who we are?
Prisha Insurance Brokers Pvt. Ltd. is a leading insurance brokerage firm dedicated to providing comprehensive insurance solutions to individuals and businesses. With a focus on customer satisfaction and personalized service, we strive to offer the best insurance products tailored to our clients' needs.
Responsibilities:
Manage end-to-end claims for GMC/GHI, GPA and GTLI policies, ensuring timely and efficient resolution.
Handle multiple claims simultaneously, including both cashless and reimbursement claims, while maintaining accuracy and service quality.
Coordinate with clients, employees/claimants, insurance companies, TPAs and hospitals to ensure seamless claim processing.
Act as the primary point of contact for claimants, providing timely updates, guidance and support throughout the claims journey.
Liaise regularly with Insurance Company Relationship Managers and relevant stakeholders for claim follow-ups and escalations.
Thoroughly review claim documents and coordinate for any additional documentation required for smooth claim settlement.
Handle claim-related endorsements and policy servicing requirements accurately and within defined timelines.
Investigate complex or disputed claims and coordinate with relevant stakeholders to facilitate fair and appropriate resolutions.
Maintain proper claim records, documentation and trackers to ensure compliance and effective claim monitoring.
Apply strong knowledge of insurance policies, claim processes and regulatory guidelines while handling cases.
Analyse claim trends and recurring concerns to identify opportunities for improved processes and customer experience.
Build and maintain strong professional relationships with clients, insurers, TPAs and other external stakeholders.
Requirements:
Minimum 1 year of experience in handling Health/Employee Benefits insurance claims.
Hands-on experience with GMC/GHI, GPA and GTLI claims.
Experience in managing cashless and reimbursement claims simultaneously.
Knowledge of claim documentation, endorsements and policy servicing.
Good understanding of health insurance processes and coordination with insurers, TPAs and hospitals.
Familiarity with IRDAI regulations and insurance industry guidelines.
Strong communication and client-handling skills.
Excellent analytical, problem-solving and strategic thinking abilities.
Strong negotiation, stakeholder management and conflict-resolution skills.
Ability to remain calm under pressure and effectively manage complex or challenging claims.
Ability to manage multiple cases while ensuring accuracy and timely follow-ups.
Location: 📍 Gurugram, Sector 47

Work arrangement
No