What are we looking for?

- About the Department:

Claims department conducts required assessments of the claims to determine its credibility. It includes conducting various assessments and performing quality checks on the processed data as per the regulatory norms in order to ensure efficiency of the departmental process.

- Purpose of the Role:

As a Senior Manager, the role involves end‑to‑end evaluation of claims submitted under group insurance policies following the demise/diagnosis of Critical illness of an insured member. The role includes verifying policy coverage, ensuring all mandatory documents are received, and conducting thorough scrutiny to establish the cause, circumstances, and admissibility of the claim.

What does the job entail?

- Leadership & Team Development: Lead a team of claim assessors, providing direction, coaching, performance monitoring, and capability building to ensure consistent and high‑quality output. Ensure all claims are evaluated strictly as per product terms, DOA, audit guidelines, and regulatory requirements. Drive quality checks and implement corrective actions where deviations are identified.

- Technical Guidance & Escalation Handling:
Support the team on complex, contested, high‑risk, or medico‑legal cases. Provide clarity on policy interpretations, documentation requirements, and risk considerations.

- Risk & Fraud Assessment: Identify inconsistencies, conduct checks for non‑disclosure, investigate suspicious patterns,



and coordinate with reinsurers, underwriters, legal team or investigation partners when needed.

- Stakeholder Coordination: Liaise with hospitals, employers (for group policies), partners, and internal teams to obtain clarifications or supplementary documents.

- Metrics & Reporting: Track and report key performance indicators including volume, TAT, NPS drivers, quality scores, team productivity, and exception trends. Use insights for continuous improvement.

- Audit & Compliance: Maintain accurate records, adhere to regulatory & internal timelines, support internal/external audits, and contribute to process improvement and quality initiatives.

- Complaints management: Conduct detailed assessment of each complaint, validate facts, review policy/claim decisions, and ensure accurate and customer‑friendly resolution within defined turnaround times. Identify systemic issues, process gaps, and training needs through trend analysis. Recommend and implementcorrective and preventive measures to minimize recurrence.

Work Experience

- Work Experience: 7+ years’ experience in Insurance Industry, preferably in claims

Essential Qualification

- Academic Qualification: Graduate/Post Graduate

- Awareness of Life-Asia/Group Asia System

Preferred Skills

- Leadership skills.

- Solid analytical abilities.

- Interpersonal skills.

- Stakeholder management.

- MS Office (Excel, PowerPoint and etc.)

- Presentation skills.

📌 Senior Manager - Claims (Mumbai)
🏢 HDFC Life
📍 Mumbai