Job Description

JOB DESCRIPTION Job Code: Job Title: Assistant Manager Claims (Operations) Band: 5A Reporting To: Deputy Manager - Claims Incumbent: Department: Operations Supervising: None JD defined on: Location: Gurgaon JOB SUMMARY: Adjudication of Life, Group & Health claims related grievance and litigations. Handling and ensuring compliant Post death benefit process Develop efficient and sustainable operations support processes for Max Life claims. Identifying customer preferences and working towards meeting/ exceeding customer satisfaction. KEY RESPONSIBILITIES: Assessment of life, group & health claims related grievance and litigations: Understanding the regulatory requirements regarding claims. Checking documentation of claims cases and preparing claims case summaries. Liaise with Legal, CMO, vendors, Doctors, hospitals, police authorities, GO, field operations, agents, other departments for claim re-adjudication Working on claims management system (Uchit) and other applications of Max Life. Post Death Benefit claims Assess Post Death Benefit claims Ensure timely settlement of all post death benefit claims Ensure that all grievances are settled within specified regulatory guidelines and Max Life claims guarantee timelines with acceptable levels of accuracy. Ensure that customer satisfaction scores for claims are within acceptable range. Reporting of regulatory submissions related to the patch. Review and approve payments and repudiations of claims within his/her specified authority limit. Partake in claims production and support related activities MEASURES OF SUCCESS: Accuracy, Quality, Productivity and Timeliness of processing and Approvals Claims Audit Ratings , compliance benchmarks and adherence to process. Customer Transaction assessment scores JOB REQUIREMENTS MINIMUM EDUCATION & EXPERIENCE- Graduate/Post Graduate with 4 to 6 years of experience in Insurance / Risk / Operations preferably in Claims management and processing Should be well versed with MS office. Added qualifications from Insurance Institute of India, LOMA, ICA etc will be preferred. KEY PERSONAL COMPETENCIES : Creativity: Ability to come up with imaginative and innovative solutions to business needs. Strong communication skills: Ability to express ideas clearly and persuasively. Planning and Organization: Effectiveness in planning and organizing activities of himself and team members. Energy: Ability to maintain a high activity level. Inter organization skills: Ability to work together with all stakeholders involved flexibility in taking feedback and modifying approach. JOB DESCRIPTION Job Code: Job Title: Assistant Manager Claims (Operations) Band: 5A Reporting To: Deputy Manager - Claims Incumbent: Department: Operations Supervising: None JD defined on: Location: Gurgaon JOB SUMMARY: Adjudication of Life, Group & Health claims related grievance and litigations. Handling and ensuring compliant Post death benefit process Develop efficient and sustainable operations support processes for Max Life claims. Identifying customer preferences and working towards meeting/ exceeding customer satisfaction. KEY RESPONSIBILITIES: Assessment of life, group & health claims related grievance and litigations: Understanding the regulatory requirements regarding claims. Checking documentation of claims cases and preparing claims case summaries. Liaise with Legal, CMO, vendors, Doctors, hospitals, police authorities, GO, field operations, agents, other departments for claim re-adjudication Working on claims management system (Uchit) and other applications of Max Life. Post Death Benefit claims Assess Post Death Benefit claims Ensure timely settlement of all post death benefit claims Ensure that all grievances are settled within specified regulatory guidelines and Max Life claims guarantee timelines with acceptable levels of accuracy. Ensure that customer satisfaction scores for claims are within acceptable range. Reporting of regulatory submissions related to the patch. Review and approve payments and repudiations of claims within his/her specified authority limit. Partake in claims production and support related activities MEASURES OF SUCCESS: Accuracy, Quality, Productivity and Timeliness of processing and Approvals Claims Audit Ratings , compliance benchmarks and adherence to process. Customer Transaction assessment scores JOB REQUIREMENTS MINIMUM EDUCATION & EXPERIENCE- Graduate/Post Graduate with 4 to 6 years of experience in Insurance / Risk / Operations preferably in Claims management and processing Should be well versed with MS office. Added qualifications from Insurance Institute of India, LOMA, ICA etc will be preferred. KEY PERSONAL COMPETENCIES : Creativity: Ability to come up with imaginative and innovative solutions to business needs. Strong communication skills: Ability to express ideas clearly and persuasively. Planning and Organization: Effectiveness in planning and organizing activities of himself and team members. Energy: Ability to maintain a high activity level. Inter organization skills: Ability to work together with all stakeholders involved flexibility in taking feedback and modifying approach.

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