Reconcile daily premium receipts and clear unallocated deposits

Medical Adjudication

Adjudicate health insurance claims with itemised settlement letters

Check cashless and reimbursement claims against policy coverage, waiting periods, sub-limits, hospital bills and medical records, and tie every deduction to its policy clause. Claims managers can approve, partly pay or repudiate with recorded reasons, and policyholders receive a letter explaining each deduction.

Claims Operations

Investigate and settle life insurance death claims

Verify the policy status, nomination, claimant identity and bank details for each death intimation, and route early or suspicious claims to field investigation against proposal disclosures. The claims review committee can decide repudiations on recorded evidence, and Finance pays interest where settlement runs late.

Fraud Monitoring Unit

Investigate suspected insurance fraud and report it to IRDAI

Log each fraud alert from claims, underwriting, distribution, staff or analytics and trace it through screening, payment holds and the investigator's written findings. The Fraud Monitoring Committee can decide denial, recovery, termination or a police complaint, and confirmed cases feed the annual IRDAI fraud return.