Job Purpose

Responsible for all Claims deliverables by managing the Claims function for the assigned business.
The role includes managing the assigned specialized business handling of any one or more of the following activities:
Claims Processing Monitoring of Indemnity and Fixed Benefit Claims Inhouse TPA processed claims. Products Development Providing Support on various claims related aspect to Product development team. System Development Key Role in development of Inhouse Claim Process System, responsible for System UAT. TPA Management Monitoring Group Claim Process, QC TAT. Responsible for TPA performance measurement, Portfolio Analysis. Doing Root Cause Analysis of portfolio performance, Claims analysis, Monitor Claims team performance metrics. Address complaints/queries from Customers, Intermediaries, Sales, other departments within the Company, Audit Training / BCP / Risk, Review, MIS / Compliance.

Job Context Major Challenges

Job Context: /Job Challenges:
Health insurance is a new and complex business with a combination of health and wellness initiatives. The business model requires the team to understand and deliver superior customer experience along with being cost effective and also having a scalable business model.
The unique challenges of the business require close review and management of Underwriting and Claims to deliver the purpose of the business effectively. Distribution: How we create specific distribution models to penetrate different market segments remains a challenge. Motivation to channel partners to place business with the co. Activate and manage agent based distribution channel across the countryLong term and short term strategic plans to increase the market share and profitability in line with the company s business objectives.



Identifying new segments, structure offerings, and value enhancers apart from creating differentiators remains a big challenge for the company s growth. Meeting varied client s expectation in terms of solutions, pricing and operational support remains a challenge. System development UAT, Claims: Indemnity Fixed benefit products (Health: Retail Corporate, PA, Travel, Hospital Cash, Critical Illnesses). Knowledge of Claims processes: Indemnity (Cashless, Reimbursement), Fixed Benefit Products. Knowledge of Claims MIS: Indemnity Fixed benefit products. Understanding of Claims systems (process flow System fields) Health Indemnity Fixed Advantages. Experience in measurement of performance (TAT, accuracy in claims adjudication). Expectations management of the Claims team. TAT expectations management for specialized business handling. Ensure uniformity in quality maintain TATs of Claims decisions.

Key Result Areas KRA (Accountabilities) (Max 1325 Characters) Supporting Actions (Max 1325 Characters) KRA1 IT Systems Development System development, UAT Indemnity Fixed benefit products (Claims) KRA2 Monitor Claims Team Performance metrics Monitor Claims transactions, authority limits, TATs
Appropriate timely resolution of escalations
Measure Claims decisions: Quality TAT (in House TPA processed Claims)
Review of o/s Claims KRA3 Recommend empowerment for Claims Officers Audit
Training KRA4 Review the Claims guidelines v/s competition Analyze business trends, recommend changes if any.
Perform cost benefit analysis.

Disclaimer : This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.

📌 Deputy Manager-Claims (Hyderabad)
🏢 Aditya Birla Insulators
📍 Hyderabad