Assistant Manager -Life Claims

At Great Eastern, we’re redefining what it means to be a claim professional. Join a passionate team where your medical knowledge, analytical skills, and attention to detail will directly impact the lives of our customers and the future of life insurance. You will be responsible for the accurate and timely assessment of life insurance claims, ensuring fair outcomes in accordance with policy terms, service standards, and regulatory requirements. You’ll also be empowered to contribute to service excellence initiatives that enhance the overall claims experience. It’s a career path that builds deep expertise in claims assessment and customer care.

• Claims Assessment & Decision Making
  Assess and approve life claims and appeals accurately within established turnaround times, in line with policy provisions and authority limits.
  Evaluate medical, financial and supporting claim documentation, ensuring appropriate claim decisions and reserve adequacy.
  Manage claim investigations and appeals, including clarification with medical institutions, policyholders, and internal stakeholders.
  Review of pending claims to ensure timely resolution and proper closure.
  Identify claim patterns and unusual or inappropriate practices and recommend improvements to strengthen claims controls and streamline claim processes.

   

   

• Stakeholder & Customer Engagement
  Collaborate with medical institutions, policyholders, and internal stakeholders to gather and clarify clinical information or outstanding requirements.
  Deliver high standards of customer service and strengthen relationships with customers and distribution channels.
   
• Delivery of Service Excellence
  Provide clear, empathetic communication timely to policyholders, claimants and agents medical professionals, and internal stakeholders, making the claims process smooth and transparent.
   
• Ensure Compliance
  Adhere to internal policies and external regulatory requirements to maintain integrity and trust in our claims operations. Take accountability in considering business and regulatory compliance risks and takes appropriate steps to mitigate the risks. Maintain awareness of industry trends on regulatory compliance, emerging threats and appropriate steps to mitigate the risks. Highlight any potential concerns/risks and proactively shares best risk management practices.
   

• Holds a Bachelor’s degree or Professional Insurance Certificate or a related insurance or healthcare discipline 
• 3–5 years of experience in relevant life and/or health claims experience 
• Strong grasp of medical practices, terminology, ICD/CPT codes, and insurance policy terms 
• Strong analytical skills with ability to interpret complex medical data, spot trends, and make sound decisions under pressure 
• High attention to detail with strong decision-making discipline 
• Detail-oriented with a proven track record of managing high processing volumes without compromising quality  
• Are customer-focused and excellent at building relationships with stakeholders and delivering clear, empathetic communication 
• Team players; are eager to learn and grow in a fast-paced, collaborative environment that values innovation and service excellence