Job Title: Assistant Vice President – Insurance Operations (Brokerage)
Location: Mohali
Department: Insurance Operations
Role Overview
The AVP – Insurance Operations (Brokerage) will oversee all post-sales operations, including claims coordination,
grievance handling, fraud screening, and legal follow-ups, across multiple insurers. This role acts as a critical liaison
between clients, insurers, hospitals, and internal teams to ensure smooth servicing, timely resolutions, and
compliance with policy terms. The ideal candidate will bring in-depth insurance knowledge, strong stakeholder
management skills, and a passion for operational efficiency.
Key Responsibilities
1. Claims Coordination (Across Insurers)
Manage the end-to-end claim process: intimation, documentation, per-authorisation, follow-ups,
reimbursement, settlement, and closure.
Act as a liaison between clients and insurers to ensure accurate and timely claim processing.
Track claims status with different insurance partners and proactively resolve delays or issues.
Maintain a centralised claims tracker and ensure client communication is clear and timely.
2. Fraud & Investigation
Monitor claims for potential red flags and escalate for insurer-driven investigation.
Coordinate with insurer-appointed investigation agencies and ensure updates are shared with clients.
Maintain records and ensure all flagged claims are handled within policy and regulatory frameworks.
3. Grievance Handling
Handle client grievances received via direct channels, insurance companies, social media, or other
sources.
Collaborate with insurer partners to ensure timely and fair resolution of client complaints.
Maintain and analyse grievance logs to identify process improvement areas.
Ensure adherence to defined turnaround times (TATs) and service-level agreements.
4. Legal & Compliance Coordination
Track and manage legal notices and health insurance litigation related to brokerage-serviced policies.
Coordinate with insurer legal teams and external counsels for timely responses and award compliance.
Support clients during legal escalations and ensure fair representation.
5. Ombudsman & Regulator Cases
Assist clients in preparing documentation for Ombudsman or IRDAI escalations.
Draft Self-Contained Notes (SCNs) and represent the client’s interest in hearings where needed.
Liaise with insurers for post-award compliance and compensation.
6. Hospital Network Support
Support clients in hospital empanelment, de-panelment, and query resolution.
Coordinate with insurance companies and TPAs to escalate issues and negotiate where possible.
Audit hospital feedback from clients and escalate recurring issues to insurer partners.
7. Internal Stakeholder Support
Provide support to Sales, Customer Service, and Relationship Management teams for policy servicing,
claim issues, and escalations.
Educate internal teams on policy features, claims procedures, and insurer-specific guidelines.
Help structure and optimize operational Sops to enhance service efficiency.
Qualifications
Bachelor’s degree in Insurance, Business Administration, or a related field (MBA preferred).
10+ years of experience in insurance operations, with at least 3 years in a broking environment.
Deep understanding of general and health insurance processes, IRDAI regulations, and claim life cycle
Deep understanding of general and health insurance processes, IRDAI regulations, and claim life cycle
management.
Strong communication, negotiation, and problem-solving skills.
Client-centric approach with a bias for action and service excellence.
