107 Claims Handling Jobs - Page 5

Role & responsibilities Impact the Bottom Line: Drive the performance of a team of Consultants, meeting and exceeding all KPI targets. Strengthen Relationships: Manage attrition, shrinkage, and other critical metrics of the team. Influence the Lives of Others: Coach and mentor Consultants, providing feedback and performance management. Keep Management Updated: Inform leadership on the latest trends of end-user customers and provide feedback to Ops Managers. Define Sutherland's Reputation: Drive organizational initiatives within the team from time to time. Preferred candidate profile Minimum 5 years experience in the field of Property & Casualty Insurance, specifically handling claims. Minimum 2 years experience in team handling. Open to rotational shifts and working from office 5 days a week.

Job Title: MBBS Medical expert- Claim & Insurance (Claim Adjudication & Medical Auditor) Location: Delhi/NCR Key Responsibilities Review and adjudicate medical claims for accuracy, completeness, and compliance with established guidelines and protocols. Evaluate clinical documentation and medical necessity to ensure appropriate utilization and minimize fraudulent claims. Support the development and implementation of medical audit frameworks and tools. Collaborate with internal teams, insurers, and government stakeholders for scheme design and policy formulation. Analyze claim trends, identify irregularities, and propose corrective and preventive actions. Provide expert insights and recommendations on complex medical claims and health benefits adjudication. Contribute to the design and delivery of training programs related to claims processing, auditing, and compliance. Assist in drafting SOPs, process manuals, and operational guidelines for public health insurance schemes. Participate in healthcare policy evaluation, scheme monitoring, and audit assignments for state and national-level projects. Required Qualifications & Skills Essential: MBBS from a recognized university. Minimum 3 years and 7 years of post-qualification experience in the healthcare or health insurance sector. Health insurance or underwriting. Healthcare practice or claim processing/medical insurance services. Healthcare schemes or claims management/medical auditing. Strong analytical skills with an investigative approach to claim validation. Knowledge of ICD codes, medical billing, and healthcare regulations. Desirable: MD from a recognized university or institute. Proven experience in health insurance, medical underwriting, claims adjudication, or medical audit. Familiarity with government-sponsored health schemes (e.g., PM-JAY, state insurance programs). Strong analytical mindset with attention to detail and a structured investigative approach. Proficiency in using health claims management systems and audit tools. Excellent written and verbal communication skills. KPMG India has a policy of providing equal opportunity for all applicants and employees regardless of their color, caste, religion, age, sex or gender, national origin, citizenship, sexual orientation, gender identity or expression, disability, or other legally protected status. As an equal opportunity employer, KPMG is committed to fostering a culture where everyone feels welcomed and is treated fairly. If you have any reasonable accessibility or accommodation requirement that will make you more comfortable during the assessment and recruitment process, please let us know and our Talent Acquisition colleague will connect with you

Job Summary: We are seeking a dedicated and detail-oriented professional to manage insurance claims on behalf of clients across various lines of business. The ideal candidate will ensure accurate documentation, effective coordination with insurers, and timely settlement of claims, while maintaining high standards of service and compliance. Key Responsibilities: Register and manage claims across multiple insurance segments (e.g., Health, Motor, Property, Marine, etc.) Liaise with clients and insurance companies to collect required claim documents and provide status updates Monitor and ensure timely follow-ups to drive claim resolution and settlements Maintain accurate claim records and prepare regular MIS reports for internal and client use Ensure adherence to regulatory requirements and internal company standards throughout the claims process Proactively follow up with insurers to expedite claim approvals and settlements Escalate delays, disputes, or complex claims to senior management or resolve through effective negotiation Candidate Requirements: Graduate degree (preferably in Commerce, Insurance, or a related field) 25 years of experience in claims handling within a broking firm or insurance company Strong knowledge of insurance products and end-to-end claim processes Effective communication and interpersonal skills, with a focus on client servicing and coordination High attention to detail and the ability to manage multiple claims simultaneously

About Navi Navi is one of the fastest-growing financial services companies in India providing Personal & Home Loans, UPI, Insurance, Mutual Funds, and Gold. Navi's mission is to deliver digital-first financial products that are simple, accessible, and affordable. Drawing on our in-house AI/ML capabilities, technology, and product expertise, Navi is dedicated to building delightful customer experiences. Founders: Sachin Bansal & Ankit Agarwal Know what makes you a Navi ite : 1. Perseverance, Passion and Commitment Passionate about Navis mission and vision Demonstrates dedication, perseverance, and high ownership Goes above and beyond by taking on additional responsibilities 2. Obsession with high-quality results Consistently creates value for the customers and stakeholders through high-quality outcomes Ensuring excellence in all aspects of work Efficiently manages time, prioritizes tasks, and achieves higher standards 3. Resilience and Adaptability Adapts quickly to new roles, responsibilities, and changing circumstances, showing resilience and agility Key Responsibilities: Review submitted health claims for accuracy, completeness, and compliance with insurance policies and applicable regulations. Identify any inconsistencies, overbilling, or discrepancies between services provided and the claims submitted Detect potential fraudulent claims by analyzing patterns and identifying suspicious activities or behaviors Providing detailed reports on audit findings, Decision accuracy, including identifying overpayments, underpayments, or fraudulent activities Recommend actions based on findings, such as denying, reducing, or adjusting claims Communicate audit results and findings to management and external stakeholders Suggest process improvements to enhance the efficiency and accuracy of the claims audit process. Stay updated with industry trends, regulations, and changes in healthcare policies that may impact claims auditing Provide guidance and training to claims team members or other related stakeholders Investigating medical claims to identify fraud Automate system and bring in improvements on claims processes Team Management- Build and manage the team of doctors supporting the function The role involves identifying discrepancies, fraud, or errors in claims to ensure compliance with health insurance policies and regulatory requirements What are some of the good to have skills for this role? Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS) Experience in handling audit Background in claims processing with clinical experience in a hospital setting Data analytics experience would be an added advantage Knowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory. Knowledge of health insurance policies and regulations, IRDAI circulars is must Strong analytical and problem-solving skills. Excellent attention to detail and ability to spot discrepancies Ability to anticipate potential problems and take appropriate corrective action Effective communication skills for working with different stakeholders Time management skills to meet deadlines. Should have a broad understanding of Claims Practice Sharp business acumen to understand health insurance claim servicing needs Excellent communication skills, including writing reports and presentations

Primary Responsibilities Team Handling Handle a team of 3050-member team, including SMEs and leads Effectively monitor the team's performance Track team's performance through intelligent reporting Conduct one-o-ones with team in timely manner Resolve team’s issues in a timely manner and motivate team to deliver in a highly complex and dynamic environment Should be able to convey leadership messaging Able to work in complex environments and should be able to multitask Prepare weekly and monthly reports/dashboards Be able to prepare and run client weekly/monthly presentations Track and report Risk and Compliance matters promptly Excellent understanding of P&C Auto Insurance processes Good skills and knowledge of leadership, facilitation, conflict resolution Excellent in logical and reasoning skills, ability to analyse the requirements Be innovative, open minded and progressive in thinking Can coordinate and do follow ups with stakeholders Excellent communication skills, both written and verbal - should be able to interact with client partners independently. Be open to work with other peers and team members as required by the Management Should be a competent user of MS Office including Word, Excel, PowerPoint, SharePoint, Teams and Outlook

Role & responsibilities: Handle and process insurance claims (Property, Casualty, Motor, Liability, or Employee Benefits) as assigned. Serve as the primary point of contact for clients, insurers, and third parties regarding claim status and inquiries. Perform claim intakes , document claim details, and validate policy coverage. Work independently (or with the AM / CSA) to manage and resolve queries from Clients and Claims adjusters / Reinsurers, seeking assistance as required ensuring escalation where necessary and resolution with minimum delay. Evaluate and negotiate settlements , ensuring fair and timely resolution. Maintain accurate and up-to-date claim records in the system. Prepare claim reports, summaries , and assist with trend analysis. Ensure compliance with regulatory standards , internal policies, and service level agreements (SLAs) . Escalate complex or fraudulent claims appropriately. Contribute to process improvements and client retention efforts. Preferred candidate profile: Minimum 5 years of experience in claims handling , insurance operations, or related fields (freshers with strong internships may be considered for junior roles). Understanding of insurance products and claims procedures . Excellent communication and customer service skills. Strong attention to detail, organizational, and time-management abilities. Proficiency with claims management software (e.g., Guidewire, Claim Center, or similar) and MS Office tools. Interested candidates can share their cv on below mentioned mail id: sonaly.sharma@crescendogroup.in References are highly appreciated.

CVminimizationrisk Join Hella Infra Market Limited as an Insurance Specialist Are you an expert in handling trade credit and corporate insurance policies? We're looking for a skilled professional to manage end-to-end insurance operations and ensure minimised across our diverse business operations. Key Responsibilities: Manage and oversee Trade Credit Insurance and ensure full compliance. Handle a broad range of corporate insurance products such as Fire, Electronic Equipment, PII, Machinery Breakdown, Liability, Contractor's Plant and Machinery, Transit, and D&O policies. Process claims and coordinate with insurers and brokers to ensure timely settlements. Draft, renew, and manage proposals, endorsements, and policy modifications . Communicate effectively with internal and external stakeholders. Negotiate coverage, premiums, and discounts to secure optimal insurance terms. Prepare and manage insurance MIS and reports for leadership review. Key Skills & Competencies: Strong understanding of corporate/general insurance and claims processing . Effective negotiation and analytical skills . Excellent verbal and written communication . Proficient in MIS/reporting . Ability to juggle multiple policies and ensure seamless execution. Share your cv at sahil.sangurdekar@infra.market Why Hella Infra Market Limited? Join one of the leading names in infrastructure, known for innovation, scale, and impact. If you thrive in high-performance environments and are ready to take ownership of critical insurance functions, this is the place for you.