Responsible for managing customer grievances, management escalations, regulatory complaints (IRDAI), and service-related issues. The role focuses on ensuring timely resolution of complaints, maintaining regulatory compliance, coordinating with internal/External stakeholders, and delivering a positive customer experience while adhering to defined service standards.
Responsibilities
- Handle customer grievances and complaints related to health claims.
- Manage management escalations and ensure prompt resolution within defined timelines.
- Respond to and resolve IRDAI, Ombudsman, and other regulatory complaints in compliance with regulatory guidelines.
- Coordinate with claims, underwriting, operations, and customer service teams to obtain required information and resolve cases.
- Draft customer and regulatory responses with accuracy and professionalism.
- Track complaint aging, turnaround time (TAT), and closure status through CRM systems.
- Conduct root cause analysis of recurring complaints and recommend corrective actions.
- Ensure adherence to company policies, regulatory requirements, and service quality standards.
- Prepare MIS reports, dashboards, and escalation summaries for management review.
- Maintain complete documentation and audit-ready records of all grievance and escalation cases.
- Support process improvement initiatives aimed at reducing complaints and enhancing customer satisfaction.
Qualifications
1. SSC
2. Higher Secondary (HSC)
3. B. Com Graduate