PRIYA SHAKYA

•Review and process life insurance claims (death claims, maturity claims, survival benefits, riders, etc.).

•Verify claimant documents such as death certificates, medical records, policy details, ID proofs, and beneficiary information.

•Validate claim eligibility based on policy terms, waiting periods, exclusions, and underwriting history.

•Enter and update claim data accurately in claims processing systems.

•Coordinate with medical examiners, hospitals, legal teams, underwriting, and fraud investigation units when required.

•Communicate with beneficiaries/agents to obtain missing information or provide claim status updates.

•Analyze claims flagged for review and escalate suspicious or contestable claims for investigation.

•Prepare settlement calculations and process payouts within defined TAT and accuracy targets.

•Maintain compliance with insurance regulatory standards, privacy laws, and internal audit requirements.

•Generate daily/weekly claim reports and contribute to continuous process improvements.

• Examined claims forms and other records to determine insurance coverage.
• Review, validate, and verify the claims, and process them as per the guidelines provided by the client.
• Ensure that all claims processed are at 100% accuracy.
• Constantly updating the case study documents and case studies.
• Reported to management on customer problems, field conditions, safety issues, and policy problems.
• Applications used in the process: PEGA, BICPS, and Content Navigator.
• Retrieved claim records to verify policyholder information and coverage before processing claims.
• Followed internal claims processing procedures to prevent fraudulent payments, guaranteeing high-quality assurance standards.

• Role: Senior Team Member.
• Process: Depository service adjustments. BANKING OPERATIONS: Research adjustment requests due to transactional discrepancies in banks of different types. and pass credit or debit to the customer or bank accordingly.
• Analysis and research on different errors and resolutions.
• Handle transactions.
• Verify customer information and accounts.
• Handle financial transactions, and manage deposits and withdrawals.
• Applications used in the process include Vector, web research, ACE, and the Bank Directory.
• Managed project timelines and delegated tasks effectively, ensuring timely completion of objectives.