Basic Details: Fill the required information about business, unit, location, position, reports to position and date of updation of JD

Business

Unit

Location*

Poornata Position Number of the job To be provided

Reports to: Poornata Position Number To be provided

Poornata Position Title of the job

Team Member - Grievance

Reports to: Poornata Position Title

Team Lead - Grievance

Function

Operations

Reports to: Function

Operations

Department*

Ops - Grievance

Reports to: Department*

Ops - Grievance

Designation of the Employee*

Asst. Manager / Deputy Manager - Grievance

Designation of the Manager*

Deputy Chief Manager

Date of writing/updation of JD

24-Aug-26

- Job Purpose: Write the purpose for which the job exists (in 2-3 lines)

The role exists to provide timely, accurate and empathetic resolution of customer grievances received through email, calls and approved channels, with particular attention to claims-related matters. It ensures adherence to internal and external requirements, protects customer trust and converts complaint insights into service, retention and process improvements.
- Dimensions: Mention quantitative or qualitative parameters that are relevant for the job and provide a better understanding of the scope and scale of the job.

Business Workforce Number To be provided Unit Workforce Number To be provided

Function Workforce Number*

To be provided

Department Workforce Number*

To be provided

Other Quantitative and Important Parameters for the job

Assigned grievance volumes; claims grievance mix; turnaround time and ageing; SLA achievement; response quality; repeat complaint and escalation rate; retention opportunities; IGMS data accuracy; root-cause closure; IRDAI reporting inputs and audit observations, as per approved targets.

- Job Context & Major Challenges: Write the specific aspects of the job that provide a challenge in the context of the Business/Unit/Function/Department/Section

About the Health Insurance Industry - The role operates in a regulated and service-intensive health insurance environment where customers expect transparent, prompt and accurate decisions. Grievance outcomes can affect trust, retention, regulatory standing and reputation, especially when claims, medical interpretation, policy provisions or multiple service partners are involved. About Aditya Birla Health Insurance - ABHI combines health insurance protection with wellness-led customer engagement and digital-first service. The grievance function supports this promise by resolving concerns fairly, protecting customer confidence and using complaint insights to strengthen products, processes and journeys.

Organisational and Functional Context - The role sits within Operations - Grievance and coordinates with Claims, Customer Service, Operations, Sales, Digital, IT, Medical, Legal, Compliance and service partners. It owns assigned cases from acknowledgement to closure, maintains accurate system records and supports regulatory reporting,



root-cause analysis and closed-loop corrective action.

Key Challenges for the role -

- Resolving sensitive claims grievances with empathy while remaining evidence-based and policy-aligned.
- Meeting regulatory and SLA timelines when resolution depends on multiple teams, systems or missing documents.
- Explaining complex decisions clearly and consistently without unsupported commitments.
- Ensuring accurate IGMS records, reporting inputs and an audit-ready trail for every case.
- Identifying genuine retention opportunities while maintaining fairness, ethics and authority limits.
- Turning individual complaints into reliable root-cause insights and sustained corrective action.
- Key Result Areas: Write the key results expected from the job and the supporting actions for each key result area

Key Result Areas

Supporting Actions End-to-End Grievance Management

- Own grievances received through email, calls and approved channels from acknowledgement through closure.
- Handle claims-related grievances with particular focus and establish a explicit understanding of the issue and decision.
- Coordinate dependencies and escalate sensitive, ageing or authority-exceeding matters promptly.

Customer Resolution and Retention

- Provide timely, accurate, fair and empathetic resolution aimed at improving customer satisfaction.
- Assess cancellation or dissatisfaction signals and pursue approved retention or conservation opportunities.
- Communicate reasons, next steps and escalation avenues clearly and track commitments to completion.

Service Levels, Productivity and Quality

- Meet grievance turnaround time, productivity, accuracy and quality KPIs under applicable SLAs.
- Prioritise cases by due date, ageing, severity and customer impact and follow up proactively.
- Participate effectively in team reviews, calibration, workload support and knowledge sharing.

Regulatory Reporting and Compliance

- Maintain disciplined understanding and use of IGMS and approved grievance platforms.
- Provide accurate and timely inputs for IRDAI complaint and grievance reporting and management information.
- Maintain complete, traceable and audit-ready records of facts, evidence, actions, approvals and correspondence.

Root Cause Analysis and Closed-Loop Action

- Conduct end-to-end RCA and distinguish isolated service failures from recurring process or system issues.
- Capture complaint categories, causes, corrective actions and closure codes accurately.
- Coordinate closed-loop actions with process owners and track agreed improvements to completion.

Product and Process Knowledge





- Maintain in-depth knowledge of products, services, policy terms, promotions, campaigns and grievance procedures.
- Interpret case facts and applicable provisions accurately and seek specialist guidance where needed.
- Stay current with product, process, system and regulatory changes while upholding high ethical standards.

Data Accuracy and System Discipline

- Record customer, policy, complaint and action details accurately and promptly in approved systems.
- Validate mandatory fields, categorisation, ownership, status, ageing and closure information.
- Protect personal, health and financial information and report workflow or system defects.

Cross-Functional and Project Contribution

- Work with Claims, Customer Service, Operations, Sales, Digital and IT to obtain facts and complete actions.
- Set clear requirements and due dates for dependencies and provide status visibility to the reporting manager.
- Contribute to assigned grievance, customer-service and process-improvement projects.
- Job Purpose of Direct Reports: Describe the job purpose of the direct report/s to the job (in 2-3 lines for each report)

Not applicable / To be confirmed. This role is currently designed as an individual contributor reporting to the Team Lead - Grievance.
- Relationships: Describe the nature and purpose of the most important contacts, except superior/team members, required to deliver the job objectives

Relationship Type

Frequency

Nature Internal - Claims Team

High

Case validation, claim rationale, documentation, corrective action and resolution inputs.

Internal - Customer Service Team

High

Customer history, channel coordination, interaction records and commitment closure.

Internal - Operations Team

Medium

Policy servicing, transaction verification, process correction and data updates.

Internal - Sales Team

Medium

Distribution context, customer communication, retention and mis-selling-related inputs.

Internal - Digital and IT

Low / As required

System issue resolution, workflow support, digital journey improvement and data correction.

Internal - Medical, Legal and Compliance

As required

Specialist review, regulatory guidance and sensitive-case decision support.

External - Customers / Policyholders / Claimants

As required

Clarification, status updates, resolution communication, retention and closure.

External - Hospitals, TPAs and Service Partners

As required

Evidence collection, transaction validation and corrective action through approved channels.

- Organizational Relationships: Provide the structure for a level above and below the position and indicate all reports

Team Lead - Grievance ↓ Team Member - Grievance

↓

No direct reports / To be confirmed

SIGN-OFF: Provide the name of the Manager and the jobholder. Signature needed for the hard copy of the JD. Hard copy to be maintained in the organizational record.

Job Holder

Reports to - Manager

Name

Signature (needed for the hard copy)

Date

📌 TM-Grievance ( Thane) (Maharashtra)
🏢 Aditya Birla Health Insurance Company
📍 Maharashtra