Job Description

The Role: Senior Claims Processor

We are seeking a highly skilled and experienced

Senior Claims Processor

to join our dedicated Claims Management team. The ideal candidate will leverage their deep technical knowledge and substantial claims processing experience, substantiated by the prestigious

Fellowship from the Insurance Institute of India (F.I.I.I.)

qualification.

This role involves handling complex, high-value, and escalated claims, ensuring strict adherence to policy wordings, regulatory guidelines, and service level agreements (SLAs).

Key Responsibilities

Complex Claim Adjudication:

Review, evaluate, and adjudicate high-value, complex, or escalated claims across [Specify Line of Business: e.g., Motor, Fire, Health, or Life] with precision and technical expertise.

Compliance & Audit:

Ensure all claim settlements comply with the Insurance Regulatory and Development Authority of India (IRDAI) regulations, internal policies, and legal requirements.

Process Efficiency:

Identify bottlenecks and suggest improvements in the claims workflow to enhance efficiency and customer satisfaction.

Mentorship & Training:

Act as a subject matter expert (SME), providing guidance and training to junior claims staff on complex claims scenarios and technical matters.

Stakeholder Communication:

Manage communication with policyholders, surveyors, loss adjusters, legal counsel, and reinsurers for smooth and timely claim resolution.

Fraud Detection:

Conduct thorough scrutiny of documents to identify and flag potential fraudulent claims.
Qualifications & Experience

Essential Requirements

Education & Certification:

Must possess a

Fellowship (F.I.I.I.) qualification from the Insurance Institute of India (III)

.

Experience:

Minimum of

[Specify Number, e.g., 5-7] years of proven, hands-on experience

in insurance claims processing/adjudication.

Technical Knowledge:

Comprehensive and deep understanding of insurance principles, policy wordings, and the end-to-end claims lifecycle for [Specify Line of Business].
Desired Skills

Strong analytical, critical thinking, and problem-solving abilities. Exceptional written and verbal communication skills in English and [Local Language, if required]. Proficiency in claims management software/systems and MS Office Suite. Proven ability to work independently, manage high-volume workloads, and meet strict deadlines.
Benefits

Competitive salary and performance-based incentives. Comprehensive medical and life insurance coverage. Opportunities for advanced professional development and leadership training. A collaborative and professionally stimulating work environment.
Job Type: Full-time

Pay: ₹35,000.00 - ₹55,000.00 per month