AM Claims Approvals

About the CustomerAn Indian consumer solutions company offering protection and assistance plans for everyday items like personal electronics, home appliances, and finances, covering accidental damage, extended warranties, and fraud protection. Founded in 2011, it partners with various brands to provide services through its app, including repair coordination, real-time claim tracking, and digital invoice storage, aiming to simplify managing warranties and everyday lossesAbout the RoleWe are committed to delivering innovative, reliable, and customer-centric protection plans. Our mission is to ensure that customers experience minimal disruption during product breakdowns through seamless claims and repair services. If you are driven by quality, compliance, and customer satisfaction, this role offers you the opportunity to work in a fast-paced, dynamic environment.Job Summary:We are looking for a detail-oriented and decision-driven Assistant Manager – Claims Approval (Repair) who will be responsible for reviewing and approving repair claims in accordance with the defined Terms and Conditions of the insurance or protection plans. This role involves close coordination with service partners, OEM- authorised centers, and internal teams to ensure fair, fast, and compliant processing of repair approvals.Key Responsibilities:
• Review and evaluate service estimates, repair reports, and supporting documents against policy Terms & Conditions.
• Approve or reject claims based on plan eligibility, exclusions, and repair justification.
• Maintain audit-ready documentation for all claims decisions.
• Coordinate with Service Ops, Field Technicians, and Service Partners to seek clarifications, where needed.
• Ensure adherence to internal SLA timelines for claim approvals.
• Work with the Legal and Compliance teams for interpretation andimplementation of policy clauses, if required.
• Provide feedback to product and service teams on recurring claimpatterns or loopholes in T&Cs.
• Ensure high accuracy in claim decisioning to avoid customer escalations or disputes.
• Support periodic internal audits, partner assessments, and RCA for declined or high-value claims.
• Track key metrics like approval rate, turnaround time (TAT), and exception handling.
• Train new team members and vendors on the approval process and compliance framework.LocationMumbaiExerience:4-6 yearsBackground and Requirements

Qualifications & Skills:

• Graduate in any discipline (Technical/Insurance/Commerce background preferred)
• 4–6 years of experience in claims approval, insurance operations, or after-sales repair decisioning.
• Strong understanding of insurance/reward protection plan clauses, including exclusions and coverage limits.
• Familiarity with common consumer durable products (TV, AC, Refrigerator, etc.) and associated repair processes.
• Good command over Excel; experience with ticketing systems or claims platforms is a plus.
• Strong analytical and documentation skills.
• Detail-oriented with high accountability for judgment-based decisions.
• Good verbal and written communication skills.
• Ability to manage workload under pressure and meet tight SLAs.Experience Required
• Prior work in a TPA (Third-Party Administrator), insurer, or extended warranty company.
• Experience with OEM service centers or claims processing platforms.
• Exposure to policy interpretation or working directly with legal/compliance teams.Technical Skills:
• Claims Assessment & Decisioning: Ability to review, interpret, and adjudicate repair estimates in line with policy T&Cs.
• Understanding of Repair Processes: Familiarity with common issues, diagnostics, and parts involved in consumer durable repairs (TVs, Refrigerators, ACs, etc.).
• Policy Interpretation: Strong grasp of insurance terms, coverage clauses, exclusions, and documentation requirements.
• Data Management: Proficient in Excel (pivot tables, filters, lookup functions) for tracking claims, TAT, and reporting.
• System Proficiency: Experience working on claims management systems, CRMs, or ticketing tools.Analytical & Judgment Skills:
• Eye for Detail: Ability to identify discrepancies or misalignments between submitted documents and policy conditions.
• Risk Assessment: Competence in assessing high-value or borderline claims with balanced judgment.
• Root Cause Analysis: Ability to flag systemic issues or repeated claim types for process or product improvements.Communication & Coordination
• Clear Communication: Ability to articulate approval/rejection rationale clearly to internal teams and partners.
• Cross-Functional Collaboration: Works effectively with Legal, Compliance, Service Ops, and Vendor Teams.
• Escalation Handling: Skilled in managing customer or partner disputes with empathy and firmness.Compliance & Process Orientation
• Audit Readiness: Maintains clear documentation trails for all approvals.
• SOP Adherence: Consistently follows process guidelines with minimal deviation.
• Integrity & Accountability: Maintains fairness and transparency in decision-making.Behavioral Competencies
• Customer-Centric Mindset: Balances business rules with customer satisfaction in decision-making.
• Problem Solving: Proactively resolves ambiguities and seeks clarification when needed.
• Time Management: Prioritizes tasks efficiently to meet SLA-bound approvals.
• Adaptability: Open to revising decisions based on new inputs or updated T&Cs.
• Team Collaboration: Supports peers in workload management and knowledge sharing.