Claims Manager

We are seeking a seasoned Head of Claims to lead and manage the full claims lifecycle across our diverse insurance portfolios—including Life, Health, and General Insurance. This leadership role is instrumental in upholding regulatory compliance, ensuring prompt and fair claim settlements, driving fraud prevention, and enhancing the overall customer experience. As the Head of Claims, you will oversee day-to-day operations, coordinate with internal and external stakeholders, and lead a team of claims professionals. You’ll play a strategic role in refining claims processes to ensure operational excellence, customer satisfaction, and adherence to IRDAI and internal audit standards. Key Responsibilities:Lead end-to-end claims processing across all product lines—from claim registration to final settlement.Assess submitted claims for eligibility, policy alignment, and documentation sufficiency.Collaborate with underwriting, legal, and medical experts for complex or disputed claims.Develop and implement fraud detection protocols and investigate suspicious cases.Monitor claims turnaround time (TAT), accuracy, customer satisfaction, and resolution timelines.Ensure complete compliance with IRDAI regulations, internal controls, and audit frameworks.Manage relationships with third-party administrators (TPAs), hospitals, garages, and surveyors.Mentor and guide the claims team to build a performance-driven, empathetic service culture.Generate detailed MIS reports and drive data-based improvements and decision-making. Qualifications & Skills:Bachelor’s degree in Insurance, Finance, Healthcare, or related field (Insurance certifications such as Licentiate from III preferred).Minimum 5 years of hands-on experience in claims processing—life, health, or motor insurance.In-depth understanding of insurance policy terms, exclusions, and industry best practices.Proficient in using claims management systems, CRMs, and digital workflow tools.Strong analytical and investigative mindset with sound decision-making skills.Excellent communication and interpersonal skills for internal coordination and external negotiation. Preferred Attributes:Experience in insurtech environments or digital claims automation platforms.Prior involvement in TPA management, grievance redressal, and regulatory audits.Proven ability to manage high-volume claims with efficiency, empathy, and integrity.