Manager / Senior Manager Individual Death Claims

Role-Specific Responsibilities within Life Insurance Individual Death Claims

Key Responsibilities

Claims Adjudication & Decision-Making

- Own end-to-end adjudication of individual death claims settlement, repudiation, or partial payment — within assigned Delegation of Authority (DOA) and liability bands.
- Review medical, financial, and policy documentation to arrive at claim decisions in line with policy terms and IRDAI guidelines.
- Escalate high sum-assured, complex, or contentious cases to the next level of authority with a clear recommendation.
- Ensure claims are processed within regulatory and internal turnaround time (TAT) norms.

Investigation & Risk Containment

- Identify early death claims (typically within 3 years of policy commencement/revival) and warrant for investigation if necessary.
- Evaluate investigation findings and apply Section 45 provisions in cases of suspected misrepresentation, non-disclosure, or fraud.
- Coordinate with RCU, empanelled investigators, medical referees, and legal counsel on suspicious or high-risk claims.
- Approve repudiation/void ab initio decisions with legally sound rationale and complete documentary evidence.

Team Leadership & SPOC Management

- Lead and mentor the individual death claims team, allocating cases by sum assured band and complexity.
- Act as Single Point of Contact (SPOC) for escalations from branches, Channels and the grievance redressal cell.
- Build team capability on medical underwriting nuances, documentation checks, and fraud-indicator recognition.

Compliance & Audit Readiness

- Ensure claims processing adheres to IRDAI claim settlement regulations and the internal claims manual/SOPs.
- Maintain audit-ready records — NOP (Notice of Proceeding), DOA approvals, and claim files — for internal, statutory, and reinsurance audits.
- Monitor and control the repudiation ratio, ensuring every repudiation letter is legally vetted and defensible.

MIS, Reporting & Reconciliation





- Track and report settlement ratio (by amount and by number of claims) against organizational targets.
- Prepare monthly, quarterly, and annual claims MIS — including BAP and authority reports — reconciled with the accounts/finance team.
- Present settlement/repudiation trend analysis and improvement insights at senior management and executive forums.

Process Improvement & Automation

- Drive automation and proactive-identification initiatives — such as death registry/API integrations — to shorten claim intimation-to-settlement cycles.
- Identify process bottlenecks and lead initiatives to improve settlement ratio, reduce repudiations, and enhance turnaround time.

Stakeholder & Customer Engagement

- Engage with nominees/beneficiaries with empathy, keeping them informed of claim status and any pending requirements.
- Liaise with reinsurers on large sum-assured claims as per treaty terms and reporting timelines.
- Coordinate with Underwriting, Legal, and Operations to resolve policy or documentation ambiguities affecting claim decisions.

Business & Sales Interface

- Interact frequently with Sales Heads and Zonal Heads to review claims pendency, TAT, and settlement performance for their respective zones/channels.
- Share regular and emerging claim trends, fraud patterns, and repudiation drivers with business teams to enable proactive course correction at the point of sale.
- Conduct real-time/ongoing analysis of claims data to flag anomalies, channel-wise risk concentration, and early warning signals to business and risk stakeholders.
- Partner with Sales and Zonal leadership on persistency, mis-selling, and early-claim patterns emerging from specific branches, agents, or channels.

Strategy,



Automation & Systems

- Drive strategic initiatives to identify and close system/process gaps, improving straight-through processing and reducing manual intervention.
- Lead automation and digitization efforts across the claims value chain, in coordination with IT and vendors.
- Participate in User Acceptance Testing (UAT) for new claims systems, product launches, and process changes, ensuring claims workability before go-live.
- Maintain strong product knowledge across the life insurance portfolio to correctly interpret exclusions, waiting periods, and rider conditions during claim adjudication.

Audit, Escalations & Complaints

- Handle internal, statutory, and reinsurance audits for the death claims function, ensuring timely closure of observations and audit queries.
- Anticipate potential escalations and complaints proactively, putting preventive controls in place rather than only reacting to issues.
- Handle claim complaints and escalations end-to-end, including those from IRDAI, Ombudsman, and other regulatory/grievance forums.
- Extend help-desk style support to internal stakeholders, branches, and channel partners for claim-related queries, ensuring quick and accurate resolution.
- Think ahead on the way forward for the function — anticipating regulatory, business, or volume changes and preparing the team and processes accordingly.

Qualifications
- Bachelor's degree in Business, Finance, or a related field; a skilled insurance qualification (e.g., III/Fellowship) is an added advantage.
- Manager: 5–8 years of experience in life insurance claims, with hands-on exposure to individual death claims.
- Senior Manager: 8–12+ years of experience, including proven experience leading a death claims/RCU function.
- Sound working knowledge of Section 45, IRDAI claim settlement regulations, and fraud/investigation protocols.
- Strong analytical, decision-making, and stakeholder management skills, with the ability to work under regulatory and TAT pressure.

📌 Manager/Senior Manager - Individual Death Claims (Hyderabad)
🏢 Shriram Life Insurance
📍 Hyderabad