Manager - Claims

3 days ago

thane, India Tata AIA Life Insurance Full time

APosition Overview

Position Title

Asst Manager / Manager – Claims

Department

Claims

Level/ Band

Asst. Manager / Manager

Role Summary:

Responsible for all system enhancements, New Projects. Responsible for PIC (Product Implementation Committee) related activities. To prepare User requirements, Test scopes, Validate Outputs received from UAT team. Train members on New Products, New deployments etc. If required conduct UAT Testings, prepare BRD document Track Pending Day1-Day2 Activities related to new products/Claim processing Responsible for product configuration Responsible for tracking production issues and resolving them. Responsible for identifying Gaps and raising requirement with IT for automation of process. Handling Projects in defined timelines, publishing projects charter, status to higher management.

BOrganizational Relationships

Reports toDirect

Sr Manager - Claims

Supervises

CJob Dimensions

Geographic Area Covered

PAN -India

StakeholdersInternal

Underwriting team, Zonal Team, IT, POS, CS, Legal & Compliance

External

External legal consultant, legal counsel, vendors.

DKey Result Areas

System Administration

·Responsible in closing all the Open PIR’s / Production related issues by Coordinating with allocated vendors.

·Raising system related requirement with IT for CR preparation.

·Liaise with IT in closing the UAT related to CR’s / PIR’s and products.

·Responsible for PIC (Product Implementation Committee) related activities. To prepare User requirements, Test scopes, Validate Outputs received from UAT team. Train members on New Products, New deployments etc.

ESkills Required

Technical

·Claims Processing.

·Sound knowledge of product contracts.

·Knowledge of medical terminologies.

·Legal Updates.

·Preparation of BRD, Project Management, Product configuration & development

·Regulatory guidelines.

·Presentation skills.

·Communication skill

F: Competencies-

Customer & Consumer Engagement

And Experience in a Hybrid World

Goes out of the way to deliver on time,

the commitments made to the

customers and consumers while

striking a balance between their

changing needs and organizational's

processes. Clearly identifies the full

range of customers to be served, their

stated needs and offers options and

suggestions to match their current

and future expectations. Works

towards integrating data, technology

and strategy into creating hybrid

customer experience solutions.

Cultivates a consumer focused

attitude among colleagues and assists

team members to focus on various

touchpoints to achieve customer

satisfaction. Strives to exceed clients

expectations by offering various

possible options to pick and choose

from which will completely satisfy

their needs and be in their best

benefit. Effects changes keeping in

mind the customer context to deliver

greater value and satisfaction to the

customers.

Business Acumen and

Domain Knowledge

Knows how claims are managed based on

set parameters and authority levels for .

by class of business, type of claim, below a

set financial limit etc. Knows how a claim is

assessed to identify if it requires specialist

handling and the resultant claims

management process for . fraud

suspicions, a large loss etc. Is able to analyze

past claims data of company, industry trends

to ensure no malicious attempt is rewarded

by fraud claimant.

Knows how claims reserving techniques are

used and how to assess whether a claim

reserve is accurate. Is able to drive teams in

effective utilization of available technology

and suggest if any upgradation is required in

systems. Is able to handle litigation forums

of dissatisfied customers with empathy. Is

able to understand medical terms and seek

support wherever required from medical

practitioners to check authenticity of filed

claims

Networking and Collaboration

Continuously stays in touch with key

networks and contacts, with an

objective of leveraging these

relationships for achieving goals. Is able

to build relations, communicate and

collaborate with cross functional team

members across all levels without

difficulty to achieve desired results.

Values team member contributions and

efforts. Persuades others by sharing

past experience and presenting

multiple arguments in order to support

the discussion / views

Change Management

Demonstrates insightful thinking and

finds innovative solutions to

challenges within and across

functions. Proactively initiates change

to achieve improvements in quality or

efficiency of work and modifies

self-behaviour and approach to deal

with changing scenarios. Explains the

process, implications and rationale for

change to those affected by it.

Analyses the strengths, weakness,

opportunities and threats of situations

and develops long term approaches

that have a positive impact on the

business. Uses sound judgment to

manage change. Champions new ideas

and supports others to plan and

implement change initiatives

Developing, Managing & Working

with Hybrid Teams

Encourages and leverages diversity by

utilizing individual strengths and actively

builds hybrid teams with

complementary skills. Proactively takes

efforts to share experience/ relevant

ideas/ information/views and provide

guidance to other team members

working remotely to achieve goals.

Effectively communicates and cascades

various business initiatives to hybrid

teams to drive business results by

leveraging technology. Anticipates and

is prepared to effectively deal with

problems and roadblocks faced while

working with hybrid teams. Encourages

work-life balance amongst team to

maintain healthy workforce. Proactively

recognizes team members for their

triumphs and encourages their self

development. Is able to adapt person

-specific approach while dealing with

various team members.

Technology,

Digital and Analytics

Ability to analyze current technological

trends, keeps track of key technological

changes in industry and other markets

Shows agility for adopting new

technology post systematic evaluation

of the the solution. Continuously stays

in touch with key networks and

contacts, with an objective of

leveraging technology for achieving

goals. Effectively balances changing

technological priorities and deliverables

under unfamiliar situations or tight

deadlines. Independently engages in

tasks requiring interpretation of

complex and often vague sets of

information. Identifies gaps in

information and makes assumptions in

order to continue analysis and/or take

action. Promotes digital literacy and

fluency in the team

G:

Behavioral (Refer Appendix for details)

Level 1

(rarely / not required)

Level 2

(required frequently)

Level 3

(essential for position)

Interpersonal skills

Communication skills

Creative thinking skills

Supervising/Leadership skills

Teamwork Skills

Influencing skills

Relationship Building skills

Decision making skills

Incumbent Characteristics

Essential

Qualification

Graduate

Experience

8-12 years

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