Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures. Responsible for the overall functioning of claim reporting and provide leadership to the claims team including people management, set performance objectives, conduct regular staff meetings and 1:1’s as well as succession planning.Demonstrate experience of leading teams in investigation, fraud risk management and compliance.Facilitate smooth conduct of audit by Statutory / Internal Auditors, Insurers and Regulators.

Work with insurers/brokers to deliver quality service and negotiate competitive premiums for the insurance requirements.Understanding of process knowledge on various manufacturing plants within the locations at risk and insure the hazards associated with their plants.Review and compare policy wordings across different classes of business to drive business with regards to scope and limitations of cover.Identify, where relevant in regular interaction with plants, depots and distributors, any potential risks facing the business and the controls that are in place to mitigate them, report all significant changes in these risks, or the effectiveness of controls, to the management in a timely manner.Estimating the Insurance benefits from various or events after assessing the probability, haircuts and legal certainty for Operational Risk.

Handled the Pan India operations for Renewals, Quality and monitor Compliance of Statutory, Local and Group policies.Designed and scoped requirement as per dynamic business needs for policy generation, policy renewal, endorsement.Functionality to allow customers and agents make required changes on renewal with real time premium calculations.Managing relationships with dealers, intermediaries, local and international banks, and ensured smooth servicing.Understands Speciality, International placements and reinsurance practices in market.Handled all required management dashboards and access queries and updates to be made in the policies.Collaborating with other members of product development team and Actuarial team to give medical/claims inputs and validation of data used for pricing.Managing the transaction issuance team and interact closely with internal customers for completion of documentation.Handover management and ensuring smooth policy issuance.Responsible for managing operations & spearheading teams for excelling business targets & service delivery metrics.Monitored service levels for corporate in terms of quote presentations, policy deliverance, and post policy issuance within the agreed TAT.

Claim Processing and Assessment of Term Life, Critical Illness & Annuity related insurance claims.Contact and/or interview claimants, doctors, medical specialists, or employees to get additional information in finalization of claims.Managing Escalations & Complaints framework for complex and high value claims and ensure internal organizational guidelines and other compliance with IRDA.Understanding of insurance fraud, able to identify and suggest mitigation plan and reporting to the regulatory body.Maintaining required claims data and preparation of MIS for claims reported and outstanding.

Job Responsibilities include claims processing and scrutiny of Hospitalization Documents.To make sure the department operates within Claims guidelines, meets productivity, TATs and quality requirements.Having strong analytical skills with a high degree of comfort dealing with insurance, ability to process claims efficiently and speedily, with analytical thinking and problem solving skills with an instinct for detecting fraud.Assist in regularly handling of complaints & grievances related to claims queries raised from internal & external agencies. Ensure that relevant records of claims processed are made and kept in accordance with the procedures and compliance manuals.