Officer - Health Insurance

Role & responsibilities

• To handle health insurance policy servicing activities including new policy issuance support, endorsements, renewals, cancellations, member additions/deletions, portability support, and policy document coordination.
• To verify proposal forms, KYC documents, policy schedules, premium details, member data, endorsements, and supporting documents for accuracy and completeness before processing.
• To coordinate with customers, sales, underwriting, claims, finance, TPAs, hospitals, brokers, and internal service teams for policy servicing, claim-related queries, and operational clarifications.
• To track and follow up on pending cases, service requests, claim coordination requirements, missing documents, premium reconciliation items, and operational exceptions within defined turnaround time.
• To maintain MIS trackers for policy servicing, renewals, endorsements, customer requests, claims support, pending cases, productivity, rework, and turnaround time.
• To support cashless and reimbursement claim coordination by ensuring timely document collection, query resolution, status follow-up, and communication with relevant stakeholders.
• To identify data discrepancies, policy exceptions, documentation gaps, service delays, and process issues, and escalate unresolved matters to the reporting manager.
• To ensure proper record maintenance, audit trails, approvals, and backup documentation for all operational activities processed.
• To assist in process improvements, standardization of operating checklists, automation of MIS reports, and improvement of service quality.
• To ensure adherence to company policies, IRDAI guidelines, health insurance regulations, data confidentiality, and compliance standards while handling policyholder and business data.