Claim Management Executive - Customer Service Team

Actively Reviewing the Applications

ICICI Lombard

India, Madhya Pradesh, Indore Full-Time On-site

Posted 12 hours ago • Apply by May 28, 2026

Job Description

Job Summary

We are seeking a qualified and experienced medical professional with a strong background in health insurance claim settlement and customer service . The ideal candidate will leverage their clinical knowledge to evaluate and process health insurance claims efficiently while ensuring a high level of customer satisfaction. This hybrid role bridges the gap between medical accuracy , regulatory compliance , and empathetic customer support .

Key Responsibilities

Medical Review Claims Adjudication:
Assess and validate medical claims based on clinical documentation and policy coverage.
Interpret diagnostic reports, treatment plans, and prescriptions to determine claim eligibility.
Coordinate with internal medical teams to ensure accuracy in claims decision-making.
Customer Interaction Support:
Communicate with policyholders, hospitals, and third-party administrators (TPAs) to explain claim decisions in a clear and professional manner.
Handle escalated or complex customer service issues involving medical claims.
Offer support and guidance on claim submission processes and documentation requirements.
Compliance Documentation:
Ensure all claims are processed in compliance with IRDAI regulations and internal guidelines.
Maintain accurate records of claim assessments, approvals, denials, and communications.

Required Qualifications

Education:
MBBS, BDS, BHMS, BAMS, or equivalent medical degree. Postgraduate qualifications in healthcare or insurance are a plus.
Experience:
Minimum 2 5 years of experience in health insurance , especially in claims processing, medical underwriting , or TPA operations .
Proven track record of customer service experience in a healthcare or insurance setting.
Skills:
Strong clinical judgment and attention to detail.
Excellent communication and interpersonal skills.
Proficient in claims management systems and MS Office.
Ability to handle sensitive medical information with confidentiality and professionalism.

HR : Harpreet

Contact: 8839890225

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