Assessment and technical evaluation of claims in accordance with fund rules and contracts to eliminating over payments or unnecessary rejections.
Drafting final assessment notes and emails to engage different stakeholders.
Assurance of compliance standards and to confer with legal counsel on claims requiring litigation.
Ensuring process accuracy as per KPI\'s, meeting compliance requirements and respond to inquiries from providers.
Sharing relevant information with team members/departments, negotiating with clients and to provide support to services team, call center and branch staff.
Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases.

·         Relationship management with corporate clients by timely responding to their queries and promptly resolve their issues to build trust and long-term relationship.
·         Negotiate settlements with corporate clients and prepare adjustment reports.
·         Calculation of loss ratio, identification of risk involved in different schemes and coordinate with internal departments.
·         Ensure complete and fair settlements keeping in view the regulatory policies and contractual agreements.
·         Ensure timely processing of client\'s request with respect to service level agreement. 
·         Drafting replies to the queries forwarded from different regulators/stakeholders.
·         Assist in implementing/upgrading SAP module & performing UAT.
·         Working on process automation and overall process improvement along with developing flow charts and user manual.
Process formation of new schemes and bulk data management