•Working for UK health insurance.•Ensure claims are complete and accurate.• Evaluate eligibility based on detailed analysis of claims documentation.• Adjudicate claims promptly, adhering to regulatory standards and policy provisions investigation and analysis.•Perform through investigation on high value or complex claims.• Analyse claims data to detect fraud pinpoint areas needing improvement.•Utilize advanced techniques to verify claims and prevent fraud communication.• Communicate effectively with policy holders and other stack holders.• Resolves inquires and disputes, maintaining focus on empathy and professionalism.• Collaborate with internal teams to ensure smooth claims processing.• Maintain accurate and comprehensive records in claims management system.• Quality assurance process improvements.• Access and enhance the accuracy and efficiency of claim handling processes.• Implement process improvements to increase productivity and reduce risk • Participate in training to stay with current industry standards.• Stay updated on relevant insurance regulations and compliance requirements.• Work closely with legal and compliance teams to address audits and equries.• Continues learning and professional development.