Claims end-end

6 days ago

Bengaluru Mumbai Pune, India Golden Opportunities Full time ₹ 4,00,000 - ₹ 12,00,000 per year

Candidate Specification & Job Description:

  • Excellent communication skills with 8+ years of work experience
  • Individual contributor roles are acceptable
  • Strong knowledge of insurance claims (General Liabilities, Auto/Motor & Direct)
  • Candidates with experience in Subrogation total loss, admin team, Property & Casualty, or Health Insurance are not preferred
  • Review and validate claims submissions for completeness and eligibility
  • Capture claim details accurately in the system, ensuring proper documentation
  • Coordinate with policyholders, agents, or brokers to obtain necessary supporting documents
  • Evaluate claim merits based on policy terms and conditions
  • Liaise with surveyors, investigators, hospitals, or repair vendors for fact verification
  • Identify potential cases of fraud or misrepresentation and escalate appropriately
  • Determine liability and admissibility in line with underwriting guidelines
  • Calculate claim amounts, applying sub-limits, deductibles, and exclusions where applicable
  • Ensure adherence to internal SLAs and regulatory timelines
  • Prepare claim settlement letters and process payments
  • Communicate claim decisions (approval/rejection) with clarity and empathy
  • Maintain complete documentation for audit and compliance purposes
  • Act as a single point of contact for claim-related queries and escalations
  • Collaborate with internal teams (Underwriting, Legal, Finance, Customer Service) for resolution
  • Drive customer satisfaction through proactive updates and transparent communication
  • Ensure adherence to IRDAI and internal compliance policies
  • Identify process gaps and contribute to claims automation and digitization initiatives
  • Analyze claims trends to recommend improvements in risk management and policy design
  • Flexible with Shifts.

Contact Person - Hemalatha

Email-

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