Job Description
Review and process life insurance claims (death claims, maturity claims, survival benefits, riders, etc.).
Verify claimant documents such as death certificates, medical records, policy details, ID proofs, and beneficiary information.
Validate claim eligibility based on policy terms, waiting periods, exclusions, and underwriting history.
Enter and update claim data accurately in claims processing systems.
Coordinate with medical examiners, hospitals, legal teams, underwriting, and fraud investigation units when required.
Communicate with beneficiaries/agents to obtain missing information or provide claim status updates.
Analyze claims flagged for review and escalate suspicious or contestable claims for investigation.
Prepare settlement calculations and process payouts within defined TAT and accuracy targets.
Maintain compliance with insurance regulatory standards, privacy laws, and internal audit requirements.
Generate daily/weekly claim reports and contribute to continuous process improvements.
