Job Description

• 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.