Claims Officer - Medical

About the role

The Claims Officer – Medical will manage medical and life insurance claims, ensuring timely reimbursement in line with agreed turnaround times (TATs) and internal protocols. The role requires close collaboration with insurers, internal teams, and clients to deliver accurate, compliant, and customer‑focused claim settlements.

Key responsibilities

• Process medical and life claims, adhering to TATs, protocols and internal processes.
• Review, analyse and coordinate claim settlements with relevant stakeholders.
• Maintain strong relationships with insurers to achieve operational objectives.
• Respond to claim‑related emails and calls within agreed TATs.
• Register claims in IIRIS, upload supporting documents and keep accurate records.
• Monitor pending claims, approvals and payments; follow up to resolve outstanding matters.
• Escalate critical or delayed issues to the Team Manager promptly.
• Handle customer complaints, maintain the complaints tracker and update the portal per DHA and CBUAE requirements.
• Provide client support via phone, email or in‑person with a customer‑focused approach.
• Ensure compliance with regulatory requirements, data privacy and confidentiality.
• Assist clients with wellness session coordination and related services.

Required profile

• Minimum of 1 month experience handling medical or life insurance claims.
• Strong technical knowledge of medical insurance products and claims processes.
• Ability to work within defined turnaround times and follow established protocols.
• Understanding of regulatory requirements, including KYC and AML‑CFT screening.
• Customer‑service orientation with professional communication skills.

Required skills

• Claims processes
• AML‑CFT screening
• KYC
• Medical insurance products
• IIRIS
• Customer service