Looking For Health Claims Doctor @ Icici Lombard
- ICICI Lombard
- 2 - 6 years
- Mumbai
- 4 months ago
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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 25 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.
Regards,
Human Resource
Job Classification
Industry: BPM / BPOFunctional Area / Department: Customer Success, Service & OperationsRole Category: Customer Success, Service & Operations - OtherRole: Customer Success, Service & Operations - OtherEmployement Type: Full timeContact Details:
Company: ICICI LombardLocation(s): Mumbai
Keyskills: TPA Medical Underwriting Claims Adjudication Claims Processing Health Insurance Health Claims Customer Service Claims Management medical officer Claim Settlement Claim Investigation
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ICICI Lombard
ICICI Lombard General Insurance Company Limited ICICI Lombard General Insurance Company Ltd is India's leading private sector general insurance company. We are a 74:26 joint venture between ICICI Bank Limited and Lombard Canada Inc. As a part of ICICI Group, we are well known for our innova...
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