Riskcovry Claims Executive Interview: Rounds, Questions and Preparation

What the job involves

A Claims Executive at a neobanking, lending or insurtech company handles the end-to-end processing of insurance claims, from intimation to settlement or rejection. You coordinate with insurers, TPAs, and customers, verify documents, track claim status, and ensure compliance with policy terms and turnaround times. In a fast-growing insurtech like Riskcovry, you may also work on claims automation, partner integrations, and reporting.

Role and Technical Knowledge

1. 1

   What are the key steps in processing an insurance claim from intimation to settlement?

   Cover intimation, document collection, verification, assessment, approval or rejection, and settlement. Mention TAT and communication at each stage.

2. 2

   How do you determine whether a claim is admissible under a policy?

   Explain checking policy schedule, coverage clauses, exclusions, deductibles, and waiting periods. Give an example of a common exclusion like pre-existing diseases.

3. 3

   What is the role of IRDAI in claims processing?

   Mention IRDAI regulations on claim settlement timelines, grievance redressal, and policyholder protection. Highlight that insurers must settle claims within specified days after receipt of last document.

4. 4

   What documents are typically required for a health insurance claim, and how would you verify them?

   List discharge summary, hospital bills, prescriptions, diagnostic reports, and ID proof. Explain cross-checking with policy terms, checking for alterations, and confirming hospital network status.

Practical Scenarios

1. 5

   A customer's motor claim is rejected due to a lapsed policy, but they claim they paid the premium on time. How do you handle this?

   Show empathy, verify payment records and grace period rules, escalate to insurer if needed, and communicate clearly. Emphasise documentation and fair resolution.

2. 6

   You suspect a claim is fraudulent. What steps would you take?

   Describe red flags like inconsistent dates, inflated bills, or repeated claims. Mention following company fraud detection protocol, seeking senior review, and not accusing the customer directly.

3. 7

   A customer is frustrated because their claim is delayed beyond TAT. How do you manage the situation?

   Acknowledge delay, apologise, provide a clear status update, and give a realistic timeline. Show you would follow up internally and keep the customer informed.

4. 8

   You have multiple claims to process and limited time. How do you prioritise?

   Prioritise based on urgency, TAT deadlines, claim value, and customer vulnerability. Mention using a checklist or software to track and avoid missing deadlines.

Behavioural and Situational

1. 9

   Tell me about a time you had to explain something complex to someone who was upset.

   Use STAR method. Focus on listening, simplifying language, and resolving the issue. Show patience and empathy.

2. 10

   Describe a situation where you worked under pressure or with a tight deadline.

   Highlight planning, prioritisation, and staying calm. Mention the outcome and what you learned.

3. 11

   How do you handle criticism or feedback from a senior or customer?

   Show openness, ask clarifying questions, and implement changes. Give an example of turning feedback into improvement.

4. 12

   Have you ever disagreed with a team member? How did you resolve it?

   Focus on respectful communication, finding common ground, and focusing on the goal. Avoid blaming others.

HR and Company Fit

1. 13

   Why do you want to work in insurtech, and why this role?

   Connect personal interest in insurance and technology, mention the company's innovative approach, and show enthusiasm for customer service.

2. 14

   Where do you see yourself in three years?

   Show ambition to grow within claims or operations, take on more responsibility, and contribute to process improvements.

3. 15

   What do you know about our company and its products?

   Research the company's offerings (e.g., embedded insurance, lending protection) and mention how claims fit into their ecosystem.

4. 16

   How do you handle repetitive tasks while maintaining accuracy?

   Emphasise attention to detail, using checklists, and taking short breaks to stay focused. Mention pride in accuracy and its impact on customer trust.