Health Claim Manager

ICICI Lombard; Indore District; On-site; INR 600,000 - 800,000; Full time

Job summary

ICICI Lombard in Indore is seeking a medical guidance professional to handle inbound calls for second opinions, review medical documents, and provide clear, ethical advice on diagnoses and treatment options. You will maintain empathy and professionalism in all customer interactions.

The role requires documenting interactions and medical assessments, summarizing observations in accessible language, and escalating complex cases to senior medical experts or specialized departments as needed, while

Responsibilities

• Handle inbound calls from customers requesting a second medical opinion.
• Review medical documents, reports, prescriptions, and diagnostic findings shared by customers.
• Provide clear, accurate, and ethical medical advice to help customers understand their diagnosis and treatment options.
• Offer guidance on alternative treatments, specialist referrals, and clinical pathways when relevant.

Job description

Key Responsibilities

1. Customer Interaction & Medical Guidance

• Handle inbound calls from customers requesting a second medical opinion.
• Review medical documents, reports, prescriptions, and diagnostic findings shared by customers.
• Provide clear, accurate, and ethical medical advice to help customers understand their diagnosis and treatment options.
• Offer guidance on alternative treatments, specialist referrals, and clinical pathways when relevant.
• Maintain empathy, respect, and professionalism in all customer interactions.

2. Clinical Assessment & Documentation

• Document all customer interactions, medical assessments, and advice provided in the system.
• Summarize key clinical observations and recommendations in easytounderstand language for customers.
• Identify cases that require escalation to senior medical experts or specialized departments.
• Ensure medical records are handled with utmost confidentiality and comply with data-protection guidelines.

3. Coordination & Collaboration

• Work closely with internal teams such as Claims, Customer Support, and Medical Underwriting for medical clarification.
• Provide inputs to claims teams when a customers medical understanding may impact claim decisions.
• Coordinate with network hospitals whenever additional clinical information is required.

4. Compliance & Quality Assurance

• Ensure all guidance is aligned with medical ethics and regulatory requirements.
• Follow the insurers protocols for customer communication and documentation.
• Participate in quality audits, training sessions, and continuous medical education modules.
• Adhere to SLAs for call handling, documentation accuracy, and customer satisfaction.

Work Location:- Indore, Madhya Pradesh.