AM Claims Approvals

Qualifications & Skills:

• Graduate in any discipline (Technical/Insurance/Commerce background preferred)

• 4–6 years of experience in claims approval, insurance operations, or after-sales repair decisioning.

• Strong understanding of insurance/reward protection plan clauses, including exclusions and coverage limits.

• Familiarity with common consumer durable products (TV, AC, Refrigerator, etc.) and associated repair processes.

• Good command over Excel; experience with ticketing systems or claims platforms is a plus.

• Strong analytical and documentation skills.

• Detail-oriented with high accountability for judgment-based decisions.

• Good verbal and written communication skills.

• Ability to manage workload under pressure and meet tight SLAs.

Experience Required

• Prior work in a TPA (Third-Party Administrator), insurer, or extended warranty company.

• Experience with OEM service centers or claims processing platforms.

• Exposure to policy interpretation or working directly with legal/compliance teams.

Technical Skills:

• Claims Assessment & Decisioning: Ability to review, interpret, and adjudicate repair estimates in line with policy T&Cs.

• Understanding of Repair Processes: Familiarity with common issues, diagnostics, and parts involved in consumer durable repairs (TVs, Refrigerators, ACs, etc.).

• Policy Interpretation: Strong grasp of insurance terms, coverage clauses, exclusions, and documentation requirements.

• Data Management: Proficient in Excel (pivot tables, filters, lookup functions) for tracking claims, TAT, and reporting.

• System Proficiency: Experience working on claims management systems, CRMs, or ticketing tools.

Analytical & Judgment Skills:

• Eye for Detail: Ability to identify discrepancies or misalignments between submitted documents and policy conditions.

• Risk Assessment: Competence in assessing high-value or borderline claims with balanced judgment.

• Root Cause Analysis: Ability to flag systemic issues or repeated claim types for process or product improvements.

Communication & Coordination

• Clear Communication: Ability to articulate approval/rejection rationale clearly to internal teams and partners.

• Cross-Functional Collaboration: Works effectively with Legal, Compliance, Service Ops, and Vendor Teams.

• Escalation Handling: Skilled in managing customer or partner disputes with empathy and firmness.

Compliance & Process Orientation

• Audit Readiness: Maintains clear documentation trails for all approvals.

• SOP Adherence: Consistently follows process guidelines with minimal deviation.

• Integrity & Accountability: Maintains fairness and transparency in decision-making.

Behavioral Competencies

• Customer-Centric Mindset: Balances business rules with customer satisfaction in decision-making.

• Problem Solving: Proactively resolves ambiguities and seeks clarification when needed.

• Time Management: Prioritizes tasks efficiently to meet SLA-bound approvals.

• Adaptability: Open to revising decisions based on new inputs or updated T&Cs.

• Team Collaboration: Supports peers in workload management and knowledge sharing.