Job Description

Job Title: Assistant Vice President - Insurance Operations (Brokerage)
Location: Mohali
Department: Insurance Operations
Role Overview
The AVP - Insurance Operations (Brokerage) will oversee all post-sales operations, including claims coordination,
grievance handling, fraud screening, and legal follow-ups, across multiple insurers. This role acts as a critical liaison
between clients, insurers, hospitals, and internal teams to ensure smooth servicing, timely resolutions, and
compliance with policy terms. The ideal candidate will bring in-depth insurance knowledge, strong stakeholder
management skills, and a passion for operational efficiency.
Key Responsibilities
1. Claims Coordination (Across Insurers)
? Manage the end-to-end claim process: intimation, documentation, per-authorisation, follow-ups,
reimbursement, settlement, and closure.
? Act as a liaison between clients and insurers to ensure accurate and timely claim processing.
? Track claims status with different insurance partners and proactively resolve delays or issues.
? Maintain a centralised claims tracker and ensure client communication is clear and timely.
2. Fraud & Investigation
? Monitor claims for potential red flags and escalate for insurer-driven investigation.
? Coordinate with insurer-appointed investigation agencies and ensure updates are shared with clients.
? Maintain records and ensure all flagged claims are handled within policy and regulatory frameworks.
3. Grievance Handling
? Handle client grievances received via direct channels, insurance companies, social media, or other
sources.
? Collaborate with insurer partners to ensure timely and fair resolution of client complaints.
? Maintain and analyse grievance logs to identify process improvement areas.
? Ensure adherence to defined turnaround times (TATs) and service-level agreements.
4. Legal & Compliance Coordination
? Track and manage legal notices and health insurance litigation related to brokerage-serviced policies.
? Coordinate with insurer legal teams and external counsels for timely responses and award compliance.
? Support clients during legal escalations and ensure fair representation.
5. Ombudsman & Regulator Cases
? Assist clients in preparing documentation for Ombudsman or IRDAI escalations.
? Draft Self-Contained Notes (SCNs) and represent the client's interest in hearings where needed.
? Liaise with insurers for post-award compliance and compensation.
6. Hospital Network Support
? Support clients in hospital empanelment, de-panelment, and query resolution.
? Coordinate with insurance companies and TPAs to escalate issues and negotiate where possible.
? Audit hospital feedback from clients and escalate recurring issues to insurer partners.
7. Internal Stakeholder Support
? Provide support to Sales, Customer Service, and Relationship Management teams for policy servicing,
claim issues, and escalations.
? Educate internal teams on policy features, claims procedures, and insurer-specific guidelines.
? Help structure and optimize operational Sops to enhance service efficiency.
Qualifications
? Bachelor's degree in Insurance, Business Administration, or a related field (MBA preferred).
? 10+ years of experience in insurance operations, with at least 3 years in a broking environment.
? Deep understanding of general and health insurance processes, IRDAI regulations, and claim life cycle
Deep understanding of general and health insurance processes, IRDAI regulations, and claim life cycle
management.
? Strong communication, negotiation, and problem-solving skills.
Client-centric approach with a bias for action and service excellence.