Handle Medical and Life claims, ensuring timely reimbursement to clients in accordance with agreed TATs, established protocols, and internal processes.
Review and analyse claims efficiently, liaising with relevant stakeholders to facilitate amicable and timely claim settlements.
Build and maintain strong working relationships with insurers at all levels to achieve operational objectives and ensure timely claim settlements in line with customer service standards.
Respond to all claims- and approval-related emails and calls within the agreed TATs, ensuring timely support to both internal and external clients.
Maintain strong technical knowledge of medical insurance products and claims processes to provide accurate and effective support.
Ensure customer satisfaction remains a key priority in all claims-related interactions and activities.
Coordinate and arrange required pre-approvals within the agreed TATs for all clients.
Register all claims in IIRIS, ensure complete and accurate uploading of supporting documents, and maintain records for future reference and requirements.
Monitor pending claims, approvals, and payment transactions, and conduct timely follow-ups to ensure all outstanding matters are resolved within the agreed TATs.
Escalate critical issues, delayed claims, pending approvals, and other unresolved matters to the Team Manager promptly.
Handle customer complaints professionally and efficiently; maintain the complaints tracker and update the complaints portal in accordance with applicable DHA and CBUAE requirements.
Respond to client enquiries via phone, email, or in-person interactions with professionalism, courtesy, and a customer-focused approach.
Ensure compliance with all applicable regulatory requirements and internal policies, particularly those relating to data privacy, confidentiality, and the handling of customer information.
For general benefits-related queries, refer to the relevant policy documents in IIRIS before advising clients and cross-check the information with the Team Lead where required.
Assist clients in coordinating and arranging wellness sessions and related services as required.
Ensure compliance with all applicable regulatory requirements relating to client onboarding and policy issuance, including KYC and AML-CFT screening.
Maintain awareness of departmental risks, responsibilities, controls, and procedures, and ensure adherence to the same.
Identify and promptly report any suspicious activities, potential fraud, or irregularities in accordance with internal policies and reporting guidelines.
Maintain accurate, complete, and up-to-date records, ensuring all required disclosures and documentation are properly maintained.
