Job Details

• Under limited supervision, employee refers to clear objectives, subject to controls on results.
• Decision making involves policy decisions on occasions where new circumstances arise and no guidelines or precedents are available. Decisions are typically based on a build up of facts and precedents.
• Establishes and implements an internal and external process for effective customer claims evaluations and feedback.
• Recommends and participates in the development and implementation of process improvements that may extend beyond area of oversight and with the approval of Operations leadership. Financial Results
• Works within the authorizations delegated in specific limits; approves and authorizes cash disbursements up to prescribed limits.
• Sharing of referral Claims numbers and metrics with respective team within the stipulated time frame. Business Development / Client Relations
• Participates in the identification of service opportunities that will encourage enhanced client claim handling.
• Exclusive onsite claims support to key client on a bi-monthly basis if required by Client
• Regular benchmarking or survey to standardize the process across the industry Public Relations (Industry Involvement)
• Keeps up-to-date with changes in claims adjudication for direct insurance claims assessors
• As per requirement tie up with external Investigation agencies/ experts across the Industry to strengthen and effectively manage risk.
• Organize regular trainings/ seminars on claims management for claims assessors for better risk management. Infrastructure: Overall Standards / Procedures and Tools
• Identifies undesirable underwriting and/or claim adjudication practices that require a need to escalate issue to departmental Head/ Managing Director so as to take appropriate measure to mitigate risk.
• Retroceded claims: assures that recoverable on large, complex retroceded claims are paid on a timely basis.
• Verifies daily claim register by scanning the register to ensure accruals are reasonable, required fields are completed and that the register is free of obvious errors. Authorizes accrual vouchers. Company Structure
• Collaborates with CMO, Underwriters, Administrators, Valuation, business development and other team members to obtain expert knowledge and to assist in identifying solutions and resolutions to problems/issues resulting in quality decisions and client satisfaction. Governance / Compliance
• Assist the Admin Team to implement administrative procedures and controls for the individual claims management functions; ensures existing procedures comply with a variety of local and international legislation (e.g., SOX compliance with claims, data protection legislation Risk Management
• Ensure all Individual and Health claims management procedures, authorities; reporting and monitoring systems are operational and as agreed within the risk management function of the company.
• Develop Business rules for Claims ensuring effective Risk Management.
• Analyse Claims data and identifying risk/ trends to curb anti selection and ensure better risk management.

• Cleared Insurance related exams such as III, LOMA
• 7+ years of experience of Handling Claims (Individual, Group &Health) Communication Skills
• Identifies the information needs of stakeholders, explains the position of the unit or the organization to them and provides appropriate advice. Complexity of Reasoning
• Development of a new result by combining known information and techniques. Activities requiring the contribution of various resources (persons, spaces, material, budget etc.).
• Understanding of the general meaning of a set of data defined with relation to a specific result.

Reference ID - GH/BFSI/JC//03042019//82920/Manager - Claims