Health/Life Insurance Claims

Importance of an insurance broker becomes well known when a claim occurs. Quality of effort & handling of claims decides an insurance broker competitiveness & credibility which further goes in industry & corporate world through word of mouth. We have dedicated team of seasonal Risk Engineers, Claims Managers from reputed Insurance Companies, TPA’s and surveyors who have handled claims by their own hand at their various capacities in their entire career. Our experienced team work through a robust, well focused & goal oriented system of claims process with best use of latest technology which certainly yield results. Claims Management team is dedicated for two main categories, one is Employee Benefit related Insurance and second category is for rest others type of insurance such as Property, Marine, Liability insurance etc.
Before Claim

It is not only post claims servicing but there are various avenues of pre-claims services which if deployed correctly can result into proper execution & efficiency of insurance policy. This is even more crucial in case of Employee Benefit insurance programs where employee is the utmost end user & beneficiary of all outcome benefits of insurance policies.

Onsite & offsite Policy awareness session :-  

In employee Benefit Insurance, it has been observed that significant quantum of service experience can be improved if end user i.e employee is well communicated about Policy Coverage & exclusion. If employee is well aware of some minimum steps to make a claim or to reach claim service manager then lot of service issues & over work may be offloaded from the shoulders of HR/Procurement team of Corporate

Therefore, We always encourage our corporate clients to conduct policy awareness directly with employee by visiting client offices & plants. We also approach all those employees through webinars, video conferencing or other related Software tools for interaction.

If such efforts are made consistently for at least some couple of years, Corporate finds their majority of employees well aware of policy benefits, exclusion, procedures which makes claims experience much convenient & trouble free.

24*7*365  AVAILABILITY  : Our team of Dedicated Relationship manager & Claims service aligned to each corporate always ensure that they shall be easily approachable round the clock, to handle any enquiry or claims related assistance.

We encourage, all our corporate client employee to keep mobile numbers & email id’s  of our dedicated service team for immediate & convenient access at any sign of use of insurance.

ONSITE HELPDESK:-  We always try to be as much as we could be available to our customers which could be right start from enquiry handling to claims payment delivery. And in this process, we like to stay in touch with our customers so that they shall be comfortably rely on us for their claims. In order to achieve this goal, We keep onsite helpdesk facility in often periodic manner to handle

  1. Customer enquiries
  2. To help them complete their claim documents
  3. To provide pick facility of their claim documents
  4. To provide assistance until claim gets completely settled

WHATS APP GROUP : –  We encourage Corporate HR/Procurement team to further encourage their employees to be stay connected with us through dedicated  “WHATS APP GROUP” created for each corporate so that communication & interaction shall be work at its best efficient manner

WEB PORTAL & MOBILE APP ASSISTANCE:- Communication is very important in employee benefit insurance which becomes even more important at time of need cause every second matters at that point. Communication mode has been changing every year in today’s rapidly changing digital world. People also like to interact, communicate, learn through latest technology. Therefore it becomes also important for us to be available & communicate with best use of latest technology.

Therefore, Our Web portal & mobile assistance helps our customers :-

        1. To see their policy information such as e-cards, benefits, coverage, exclusion etc
        2. To intimate claim
        3. To remain updated about their claim status
        4. To get further assistance of other tools such as network hospital search, wellness discount etc
During Claim

24*7*365  AVAILABILITY OF DEDICATED SERVICE MANAGER  : Claim in employee benefit insurance can trigger at any time so thus the need of insurance partners, Therefore, We always ensure that our customers could easily & convenient approach dedicated service manager over their mobile which helps customer to calm & worriless about their claims process & outcome.

CONSISTENT EMAIL & MOBILE ALERTS: Our systems always keep customer updated about their claims or other information through consistent email & Mobile alerts

SPEEDY CLAIM PROCESS : We suggest our clients to choose their insurance broking partner wisely so do we work on same business philosophy by choosing appropriate & best insurance company, surveyor, TPA’s while designing an insurance program.

Our choice of insurance company, TPA’s & other partner, is based on their knowledge expertise, robust system & latest infrastructure  so that client shall feel ease of convenience while using policy benefits.

DISPUTE FREE PROCESS  :- We do not believe on simply passing the information from insurance company to customer but our team of experienced professional even analyses insurer conclusion/opinion with Policy terms & condition and solicitates with insurer, TPA, Surveyor if their conclusion /opinion are found to be other wise. Our efforts continues until every claim get settled/concluded as per policy terms & condition only without any gap of understanding or knowledge.

LEGAL RECOURSE :-   One of the main & conclusive object to insurance broking partner is that claim which is the ultimate outcome of insurance policy, shall conclude amicably, reasonably & to its best interpretation as per policy terms & condition. Therefore, We do not leave our customer hand even in circumstances where insurer does not process claim as per policy terms & condition. We do take legal opinion & suggest, advise & walk along with our customers during legal recourse of an disputed or improper settled claim.

FRAUD DETECTION : –One of the disadvantage for an employee being end user in employee benefit insurance is that, Corporate cannot monitor & control, any misuse or fraud in claims. Therefore, We have  robust system, check, and our experienced professional monitoring in place, so that fraud may be timely detected & reported to Corporate so that actions may well be taken in time. In larger organization, it is too crucial, where claims occur in thousand count and if there is no proper system placed for fraud detection then it may result into expensive insurance cost every year.

Beyond Claim

Particularly, In Employee benefit related insurance, There are many other areas beyond claims services  where if right amount & Quality of effort are made, then Policy user experience even goes more productive.

WELLNESS PROGRAMS :- Our onsite & offsite wellness & recreational  activities conducted in periodic manner helps our corporate customers in improving their human capital productivity & efficiency by way of contributing in

  1. Improving Employee Health Behaviours
  2. Reducing employee elevated health risks
  3. Reducing Employees  healthcare cost
  4. Reducing absenteeism due to unmonitored health risk
  5. Improves employee recruitment & retention
  6. Building & sustaining high employee morale

We provide appropriate & effective  bouquet  of wellness programs for our corporate customers

WELLNESS DISCOUNT :-   We have wide range of health care & wellness centres empanelled with us where our corporate customers receive significant portion of discount on paid services at those centres.

  1. Such discount helps our corporate customer reduce their claim outgo due to reduce cost in pre/post hospitalization expenses
  2. This provides an indirect monetary benefit by Corporate to their employees
  3. It also encourages employees to go through preventive health check on periodic manner which improves Employees health behaviour.

PERIODIC CLAIM UPDATES & REVIEW MEETINGS :- Meeting a customer always helps, its even more important in insurance  therefore We meet our client in periodic manner to update & provide them  review about

  1. Their insurance Policy claim exposure
  2. Employees Issues, resolution and feedback for respective period
  3.  Claim controlling measures
  4. Impact of claims exposure for next renewal

DATA ANALYTICS :-  Insurance  cost majorly depends upon information & its quality. Information quality is even more realised during insurance cost evaluation & finalization ,when each aspect of information has significant relevance in premium cost negotiation. There we have professional Data Analytics team who jointly work with our claims & underwriting team in order gain valuable information for a respective Corporate Industry, business trend, profile, Claims exposure etc which helps a corporate achieve their financial objective of having insurance.

Non Health/Life Insurance Claims

Non Health/Life Insurance such as Property/Marine/Liability etc insurance claims usually are in nature of lower probability but higher quantum. Quantum of claims in these policies could even hold value of significant portion of Corporate entire financial balance sheet. Therefore, Delay in claims of these policies could put in financial trouble.

Therefore, We ensure that our Risk & Claims management team in this category of insurance, consisted of seasoned & veteran professionals in which every member is having at least a decade experience who accompany our customers right from the claim intimation to Claim survey visit, document preparation until claim gets settled.
Before Claim

PRE-AGREED LOSS SUVEYOR & ADJUSTER : Our business philosophy firmly believes in valued & credible partnership therefore we value & maintain industry relationship with almost every credible & competitive IRDAI licensed  Loss Surveyor & Adjusters. We offer pre-agreed panel of Loss surveyor & adjusters while any insurance policy closure in mutual consent of insurer & Insured so that customer could be assured of credibility of all partners with whom they might need to interact.

RISK AUDIT, RISK MANAGEMENT & CONTROL SERVICES :-  Knowing the risk is important to control & mitigate those loss/damages which might occur from those risk. Insurance works more efficiently if risks are properly & accurately known & managed by Insured. This is why we often conduct Pre & Post Policy Inspection of customer business & facilities through our Risk Engineers & consultants such as architect, chartered accountants etc

Objectives of such Risk Inspection:-

  1. To understand Customer existing business all operations & facilities to evaluate risks involved in it
  2. Thus Advising client about those risks and modes of mitigating them by either taking respective insurance or by taking some extra controlling measures or both.
  3. Preparing or adding value/knowledge addition in customer standard operating procedure(SOP) for their business operation & facilities
  4. Assuring that customer insurance policies coverage, exclusion & warranties  are directly responding to their business operations and remove if there is any gap in them.
  5. Insurance companies also prefer underwriting healthier & reasonable risk. Also, Insurance company charges reasonably & more economical insurance cost for customers who have  proper risk control measures in their business operations.

Therefore  such risk audit & control services help customer improve their risk factor thus becoming healthier risk for insurance company to underwrite which ultimately yields monetary  benefits as well by saving insurance cost consistently.

During Claim

JOINT INSPECTION :-  Our claims professional accompany our customers in each visit of Surveyor to loss site along with all meetings & interaction.  This provides much relief to the customer cause every corporate customer prefers themselves to be represented by industry best experts. This is also important to ensure that All but reasonable & appropriate documentations are demanded from customer & claims has been brought in right manner to their conclusion with out any hassles from either of the party.

CLAIM DOCUMENT PREPARATION ASSISTANCE :- Collection & preparation of claim documents in co-ordination with multiple department within a company is not an easy & convenient task. We understand this issue. Therefore, Our Claims professional act as an extended arm of Customer by co-ordinating with in multiple department of customers in collecting & preparation of claim documents. This ensures that Documents are prepared in complete & accurate manner which improves claim settlement time and helps reduce disputes as well.

SOLICITATION WITH INSURER & SURVEYOR : –  We do not believe in simply just communicating information/documents from customer to insurance company/surveyor & vice-versa. We analyse them and bring it to its correct interpretation & implementation among all parties. We solicitate on behalf of customer with insurance company/surveyor to bring claim settlement to its correct & appropriate conclusion in terms of outcome & quantum.

LEGAL RECOURSE :- One of the main & conclusive object to insurance broking partner is that claim which is the ultimate outcome of insurance policy, shall conclude amicably, reasonably & to its best interpretation as per policy terms & condition. Therefore, We do not leave our customer hand even in circumstances where insurer does not process claim as per policy terms & condition. We do take legal opinion & suggest, advise & walk along with our customers during legal recourse of an disputed or improper settled claim.

Risk Management Services

Risk is about uncertainty. If you put a framework around that uncertainty, then you effectively de-risk your project. And that means you can move much more confidently to achieve your goals. By identifying and managing a comprehensive list of risks, unpleasant surprises and barriers can be reduced and golden opportunities discovered. Risk management refers to the practice of identifying potential risks in advance, analyzing them and taking precautionary steps to reduce/curb the risk.

When an entity makes an investment decision, it exposes itself to a number of financial risk. The risk management process also helps to resolve problems when they occur, because those problems have been envisaged, and plans to treat them have already been developed and agreed. You avoid impulsive reactions and going into “fire-fighting” mode to rectify problems that could have been anticipated. This makes for happier, less stressed project teams and stakeholders. The end result is that you minimize the impacts of project threats and capture the opportunities that occur.

Step 1: Risk Identification

Reveals what, where, when, why, and how something could happen and potential effects on the objectives. We uncover, recognize and describe risks that might affect your project or its outcomes. There are a number of techniques you can use to find project risks.

Step 2: Analyze the risk

Establish probability and potential outcomes of each risk. What is the potential affect to goals and objectives. Once risks are identified We determine the likelihood and consequence of each risk. You develop an understanding of the nature of the risk and its potential to affect project goals and objectives.

Step 3: Evaluate or Rank the Risk

Compare risks’ magnitude and rank risks according to prominence and consequence We evaluate or rank the risk by determining the risk magnitude, which is the combination of likelihood and consequence. You make decisions about whether the risk is acceptable or whether it is serious enough to warrant treatment.

Step 4: Treat the Risk

Also considered Risk Response Planning. Create risk mitigation strategies, preventative care, and contingency plans based on assessed risk value. This is also referred to as Risk Response Planning. During this step we assess your highest ranked risks and set out a plan to treat or modify these risks to achieve acceptable risk levels. How can you minimize the probability of the negative risks as well as enhancing the opportunities? You create risk mitigation strategies, preventive plans and contingency plans in this step.

Step 5: Monitor and Review the risk

Risk management is a non-stop process that adapts and changes over time. Repeating the processes assure maximum coverage of known and unknown risks. Register can be used to efficiently monitor risks as well as streamline the data for universal implementation. The register is a predetermined organizational method documenting the steps, data, and results of risk management projects that can be shared and interpreted easily with other businesses. They are consistent, compact, concise, complete, use control, as well as invite communication and commitment.

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Orange Capital Insurance Broking Private Limited,
Ground Floor, S-145, Uppal South End
Sohna Road, Sector-49, Gurugram, Haryana-122001

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OUR LOCATIONSWhere to find us
GET IN TOUCHOrange Capital Social Links
Feel our social presence that seamlessly covers key insurance indicators.

IRDA Registration Number : 704 | CIN : U66000HR2019PTC082383 | Category : Direct Broker (Life & General including Health) | License Period : 17-04-2020 to 16-04-2023

IRDA Registration Number : 704
CIN : U66000HR2019PTC082383
Category : Direct Broker (Life, General, Health)
License Period : 17-04-2020 to 16-04-2023

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