AM - Claims (Thane)

Job purpose

This role is centered on managing claims operations with a strong focus on indemnity claims, including cashless and reimbursement processes, as well as fixed benefit products. It also requires familiarity with claims systems and workflows across health, personal accident, and travel insurance.

Core accountabilities

• Oversee claims process knowledge for indemnity-based products, including cashless and reimbursement claims, along with fixed benefit offerings.
• Work with claims systems and understand the end-to-end flow and relevant system fields for health, PA, and travel lines.
• Track and improve claims performance through metrics such as turnaround time and adjudication accuracy.
• Manage expectations across the claims team and ensure alignment on delivery standards.
• Handle turnaround-time commitments and expectation management for specialized business segments.
• Drive consistency in claims quality while meeting defined turnaround times for claims decisions.
• Establish, document, and maintain operating standards and protocols for the claims function.
• Review claims decisions to ensure they follow claims guidelines, remain consistent, and stay within approval authority limits for both in-house and TPA claims.

Additional information

The position is based in Thane, Maharashtra, India and is a full-time onsite role.