Claims Officer
The Oriental Insurance Company (Al-Mulla Group), Kuwait
مجموع سنوات الخبرة :18 years, 4 أشهر
• Handling Non-Motor Claims: Claim intimation, validation, registration and initiating the Claim in system
• Coordinating with the Insured/Re-Insurer/Co-Insurance/Surveyor, Facultative analysis claims activities
• Scrutinizing Non-Motor Claims, helping Clients in resolving their queries related to Policy and Claims coordinating with TPA.
• Issue monthly reports: Statement of Claims intimated and Paid, WCP XL and Whole XL to Management, Kuwait Ministry
• Issue Claims Loss Ratio report
• Protect interest of Insurance Company the adjuster represents, Correspondence with loss adjuster.
• When dealing with Claimants, follow up with recovery and salvage formalities
• Handling Legal payments by coordinating with Legal Attorney for legal cases
Handle Health Insurance policies of Corporate clients
•Coordination with HR/ Insurer Co. / Employees for GMC, GPA and GTLI products
•Renewal activities for Policies
•Prepare Quote comparison report
•Enrollment and data related work
•Portal & mobile app related work for service enhancement.
•Cashless & reimbursement claims handling
•Employee orientations presentations
•Monitor the helpdesk activity with TPA
Visits to Insurer Co., corporate HR for yearly orientation program.
• Handle Health Insurance policies (GMC) of Corporate clients with the team of 5
• Coordinate with HR/ Insurer Co./ Employees /Brokers/ Insurer agents
• Review of portfolio analysis by TAT study, Monitor the team activity for servicing of the policies i.e. adhering TAT’s for defined process after placing the policies like Cards, Concurrence, Endorsements, policy terms and its updations within defined TAT & agreed SLA
• Monitor Renewal of existing business & its communications
• Educate Clients through service presentation about policy terms & condition & guide how to proceed to co-ordinate with Medi Assist in near future along with its new technology and innovations
• Arrange meeting with Clients/ Insurer Co./ Brokers to solve their queries on monthly basis & quarterly review feedback for better understanding and services
• Handling reimbursement claims of corporate clients
• Attending all claims/Enrollment related queries of Employees/HR including Cashless/Reimbursement claims
• Handle queries of clients through Outlook/Web portal day to day basis on defined TAT
• Coordinate with various TPA Coordinators/Asst-Sr. Manager for the in process claims/deficiency claims of employees to get the status on defined TAT which is provided to clients
• Maintain all claim records in Word MIS format on daily basis for internal audit purpose
• Coordinate with Insurance Companies Divisional Manager/Asst Sr Manager for Concurrence/ Grievance/ Endorsement cases to get the approval for re-processing
• Handle escalations issues of the clients through mails/calls/con-call
ole : Claims Executive
• Coordination with internal Networks team for cashless claims
• Prepare weekly reports related to pending cases; Preparing daily reports to Insurers
• Claim Intimation and approval related Coordination
• Register the claim intimation received at email portal
• Approval follow ups for Delay Submission, claim on photocopies etc.
• Handle end to end General queries related to edition and updated related receive from internal team, settlement letter, Claim amount miss match, Lost Cheque, Error in registration
Role : Document Recovery Executive
• Medi-claim related Queries for Reimbursement cases
• Handle claims cases as per the Insurer’s standards-IRDA
• Handle Pending Claimant cases with available resources
• Claims Processing; Maintaining and following TAT for rejection claims
• Handle Customer Queries (Inbound calls) from claimant, HR, Broker, A/C Manager etc. Handling end to end escalations related to claims
Inbound Customer care query handling for product-Credit Cards,
preparing drafts, crossing selling of other products of bank like
Personal loans, home loans, SB A/C, other banking products,
updating information to customer for new arrivals of the products
Chq. Clearing, Updating of the same, registration of the
Transaction, RBI Reporting, SF maintenance, scanning, coding of forms, etc.
Daily updating of funds, Maintain all Bill payments,
•HR - A/C opening for new Employee, PD Form, Resume Code form & etc.
Promotion of Credit Cards, Demat a/c, Saving a/c, Current a/c & etc. Also sourcing direct banking channels like Phone banking, Net banking, Mobile banking, Bill payment & Debit cards
•Verification of documents required for Account opening & conversion of all the Leads given by Personal bankers, Phone bankers
•Cross Selling & generating leads for various other bank products like Housing loans, Loan against Securities, Personal Loans etc. and Third party products like Mutual Funds & RBI Bonds