Role & responsibilities

1. Claims Operations Management

- Oversee registration, assessment, processing and settlement of claims in line with policy terms, company guidelines and SLAs.
- Ensure claims are handled efficiently, accurately and within agreed turnaround times, with proper documentation and system updates.
- Review and approve claims within delegated authority; escalate highvalue, complex or disputed cases as per matrix.

1. Technical Assessment & Quality

- Interpret policy wordings, endorsements and exclusions to determine coverage and liability.
- Liaise with surveyors, loss adjusters, investigators, garages, hospitals and other service providers, ensuring quality and costeffective reports and repairs.
- Conduct rootcause analysis on complex or repeat claims issues and drive corrective actions in process or underwriting.

1. Customer Service & Dispute Resolution

- Handle escalated customer complaints and grievances related to claims; ensure fair, transparent and timely resolution.
- Communicate clearly with policyholders, intermediaries and partners on claim decisions, requirements and next steps.
- Support initiatives to improve customer satisfaction and Net Promoter Score (NPS) in claims.

1. Cost Control, Reserving & Fraud Management

- Monitor claim costs, reserves and leakage; ensure adequate reserving and timely revisions based on development of claims.
- Identify potential fraudulent or exaggerated claims, coordinate investigations, and recommend appropriate action.
- Provide inputs to reinsurance and finance teams on large losses, recoveries, subrogation and litigation exposure.

1. People Management & Process Improvement

- Lead and mentor a team of claims officers/executives; set targets, allocate workload,



monitor performance and conduct regular reviews.
- Train team members on policy coverage, claims procedures, documentation standards, regulatory changes and soft skills.
- Continuously review and improve claims workflows, SOPs and systems to enhance efficiency, control and customer experience.

1. Compliance, Governance & Reporting

- Ensure adherence to IRDAI regulations, internal policies, audit requirements and company claims philosophy.
- Coordinate with legal teams and external counsel on litigated/critical matters; attend court as company representative where required.
- Prepare and publish periodic MIS and analytics on claims trends, TAT, repudiation, recovery, and portfolio performance for management review.

Preferred candidate profile

Qualifications & Experience

- Graduate in any discipline; preferred: Law / Engineering / Insurance / Finance; skilled insurance qualifications (III / CII) added advantage.
- 5-10 years of experience in general insurance claims (motor / non-motor / health / property), with minimum 23 years in a supervisory / managerial role.
- Strong knowledge of policy wordings, claims procedures, survey/loss adjusting practices, and local insurance regulations.

Skills & Competencies

- Strong analytical and decisionmaking skills; ability to balance customer centricity with loss minimisation.
- Excellent communication, negotiation and stakeholder management skills (customers, intermediaries, surveyors, lawyers, internal teams).
- People leadership, coaching and performance management capabilities.
- Proficiency in claims management systems, MS Excel/PowerPoint and MIS/reporting.
- High integrity, attention to detail and ability to work under pressure with large case volumes.

For more information please call Gopakumar@ (phone hidden)

📌 SM- Commercial claims - General Insurance- Chennai-12 lacs
🏢 Wego Consultants
📍 Chennai