19 Claims Operations Jobs

Genpact is a global professional services and solutions firm committed to delivering outcomes that shape the future. With a workforce of over 125,000 individuals spread across 30+ countries, we are driven by curiosity, entrepreneurial agility, and the desire to create lasting value for our clients. Our purpose, the relentless pursuit of a world that works better for people, empowers us to serve and transform leading enterprises, including the Fortune Global 500, leveraging our deep business and industry knowledge, digital operations services, and expertise in data, technology, and AI. We are currently seeking applications for the role of Assistant Vice President, Insurance Claims Operations. We are looking for an individual with extensive domain expertise in P&C Insurance - Claims and a proven track record in managing service delivery for large operations. As the Assistant Vice President, your responsibilities will include: - Managing large P&C Claims operations efficiently - Being accountable for managing clients and internal stakeholders, and collaborating with them to successfully handle operational delivery - Driving the achievement and surpassing of all internal and customer key metrics - Planning and leading employee engagement, rewards, and recognition initiatives to enhance performance and reduce attrition - Developing staff through leadership competency assessments, promoting training and career planning, coaching for career development, and providing input into hiring decisions - Monitoring cluster performance against established standards, providing performance feedback on supervisors, and ensuring alignment of processes to minimize revenue loss by coordinating with other units - Ensuring compliance with department, business unit, and regulatory agency standards and practices - Cultivating a culture of continuous risk assessment, mitigation, and effective customer communication - Reviewing E2E metrics, identifying risks and opportunities, owning the standard process design and control environment - Driving transformation projects, including operations, digital asset implementation, standard methodologies framework, case studies, and benchmarking to enhance process efficiency and effectiveness - Building impactful customer relationships, improving Net Promoter Score, maintaining an existing book of business, and driving revenue growth Qualifications we are looking for: Minimum Qualifications / Skills: - Non-Technical Graduate - Relevant industry experience primarily in managing Insurance Claims operations Preferred Qualifications / Skills: - In-depth E2E understanding of P&C Claims - Previous experience in managing Claims + Underwriting functions and knowledge of Canadian Insurance will be advantageous - Excellent operating skills in people management, client management, and other operational frameworks - Exceptional verbal and written communication and presentation skills, including the ability to prepare and present independently and confidently to senior leadership within Genpact and client organizations - Proven track record of leveraging lean Six Sigma framework for continuous performance improvement - Sound knowledge of various digital technologies in the market, such as RPA, AI, NLP, and ML, with experience in implementing one or more of these technologies being a plus - Exposure to systematically evaluating business opportunities and an ambitious attitude to build on existing capabilities - Strong cross-functional collaboration skills If you believe you possess the qualifications and skills we are looking for, we encourage you to apply for the position of Assistant Vice President, Insurance Claims Operations.,

Ready to shape the future of work At Genpact, we don&rsquot just adapt to change&mdashwe drive it. AI and digital innovation are redefining industries, and we&rsquore leading the charge. Genpact&rsquos AI Gigafactory, our industry-first accelerator, is an example of how we&rsquore scaling advanced technology solutions to help global enterprises work smarter, grow faster, and transform at scale. From large-scale models to agentic AI, our breakthrough solutions tackle companies most complex challenges. If you thrive in a fast-moving, tech-driven environment, love solving real-world problems, and want to be part of a team that&rsquos shaping the future, this is your moment. Genpact (NYSE: G) is an advanced technology services and solutions company that delivers lasting value for leading enterprises globally. Through our deep business knowledge, operational excellence, and cutting-edge solutions - we help companies across industries get ahead and stay ahead. Powered by curiosity, courage, and innovation, our teams implement data, technology, and AI to create tomorrow, today. Get to know us at genpact.com and on LinkedIn, X, YouTube, and Facebook. We are inviting applications for the role of Assistant Manager/ D omain Trainee - London Market - Claims In this role, you will be responsible for Resource should have worked in Insurance vertical with Claims operations from FNOL set up to Payments issuance functions Responsibilities End to end knowledge of claim lifecycle and P&C products Experience of handling new transitions, phasing from strategic assessment till operations set up with zero surprise delivery Ability to build positive collaborations across business and technical communities Participates on operational improvement initiatives for business divisions Develop contingency strategies and plans for staffing changes Qualifications we seek in you Minimum qualifications Graduate from a recognized university Excellent P&C Insurance knowledge Should have experience and understanding of processes related to Claim Lifecycle Excellent analytical skills. Preferred qualifications Good to have London market or Broker experience Ability to multi task and prioritize activities Ability to work independently Transition and operations set up experience Experience of front ending with customer Why join Genpact . Be a transformation leader - Work at the cutting edge of AI, automation, and digital innovation . Make an impact - Drive change for global enterprises and solve business challenges that matter . Accelerate your career Get hands-on experience, mentorship, and continuous learning opportunities . Work with the best - Join 140,000+ bold thinkers and problem-solvers who push boundaries every day . Thrive in a values-driven culture - Our courage, curiosity, and incisiveness - built on a foundation of integrity and inclusion - allow your ideas to fuel progress Come join the tech shapers and growth makers at Genpact and take your career in the only direction that matters: Up. Let&rsquos build tomorrow together. Genpact is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, religion or belief, sex, age, national origin, citizenship status, marital status, military/veteran status, genetic information, sexual orientation, gender identity, physical or mental disability or any other characteristic protected by applicable laws. Genpact is committed to creating a dynamic work environment that values respect and integrity, customer focus, and innovation. Furthermore, please do note that Genpact does not charge fees to process job applications and applicants are not required to pay to participate in our hiring process in any other way. Examples of such scams include purchasing a %27starter kit,%27 paying to apply, or purchasing equipment or training.

To lead and manage the claims operations by ensuring timely, fair, and compliant claim settlements, optimizing processes for efficiency, and supporting strategic goals through data-driven decision-making and cross-functional collaboration Ensure timely and accurate settlement of claims within defined turnaround times (TATs) Maintain adherence to IRDAI regulations and internal claims policies Identify and mitigate fraudulent claims through effective investigation and controls Enhance claimant experience through transparent communication and service excellence Lead, mentor, and upskill the claims team to improve performance and accountability Optimize claim payouts and reduce leakage through data-driven decision-making Collaborate with cross functional teams for complex claim resolutions Timely and accurate claim settlements to avoid interest penalties Detection and prevention of fraudulent claims to reduce financial loss Accurate payout calculations aligned with policy terms Reduction in claim rework or overpayments Minimal customer complaints or escalations Timely and empathetic communication with beneficiaries Clear guidance provided throughout the claim process Claims processed within defined turnaround time (TAT) 100% compliance with regulatory and internal audit standard Effective coordination with legal and other departments Accurate and complete documentation for each claim Contributions to process improvement initiatives

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers. Required Qualifications: 6+ months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education.

As the Insurance Partner Manager for Global Shared Services (GSS) at Liberty Mutual Insurance, you will play a crucial role in supporting the team based in India with governance, talent management, and strategy aligned to various Liberty Mutual Retail Market - Claims operations worldwide. Reporting to the GSS Governance and Transformation Lead, you will oversee the execution of the Enterprise-wide outsourcing workstream, ensuring consistent expectations and high-quality delivery standards from strategic partners in an onshore/offshore environment. This role, based in the Hybrid model location of Delhi NCR, requires a candidate with a Masters in business administration from a Top Tier Institute, with a preference for higher education in P&C Insurance. The ideal candidate should have over 15 years of work experience in Insurance Operations, Governance, Transition, and BPO management within the P&C domain, along with SME level knowledge in Insurance claims operations. Familiarity with systems like Guidewire Claim Center, Brite core, Applied Epic, and 360 site view is preferred, as well as an understanding of modern claims operations transformation opportunities. Key responsibilities include maintaining a strong governance framework, performance management, talent development programs, staffing and hiring needs, and fostering closer relationships with internal stakeholders and strategic vendor partners. The role also involves supporting business identification and opportunities in global markets related to outsourcing, feasibility analysis, and transitions. The successful candidate will possess strong organizational and multi-tasking skills, stakeholder management abilities at CXO level, and a strategic business judgment with a sense of urgency. They should be self-motivated, creative problem-solvers, and able to work independently or in a team environment. Flexibility to work across time zones, travel internationally as needed, and collaborate with cross-functional teams are essential qualities for this role. In return for your hard work and commitment, Liberty Mutual offers industry-leading salary, benefits, and rewards that support your well-being and personal growth. The company values integrity, innovation, and positive change, making it a rewarding environment for talented professionals to thrive and make a meaningful impact.,

Genpact (NYSE: G) is a global professional services and solutions firm delivering outcomes that shape the future. Our 125,000+ people across 30+ countries are driven by our innate curiosity, entrepreneurial agility, and desire to create lasting value for clients. Powered by our purpose - the relentless pursuit of a world that works better for people - we serve and transform leading enterprises, including the Fortune Global 500, with our deep business and industry knowledge, digital operations services, and expertise in data, technology, and AI. We are inviting applications for the role of Management Trainee/ Domain Trainee - P&C Insurance In this role, you will be responsible for Resource should have worked in Insurance vertical with Claims operations from FNOL set up to Payments issuance functions Responsibilities . End to end knowledge of P&C products . Experience of handling new transitions, phasing from strategic assessment till operations set up with zero surprise delivery . Ability to build positive collaborations across business and technical communities . Participates on operational improvement initiatives for business divisions . Develop contingency strategies and plans for staffing changes Qualifications we seek in you Minimum qualifications . Graduate from a recognized university . Excellent P&C Insurance knowledge . Should have experience and understanding of processes related to Claim Lifecycle . Excellent analytical skills. Preferred qualifications . Ability to multitask and prioritize activities . Ability to work independently . Transition and operations set up experience . Experience of front ending with customer Genpact is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, religion or belief, sex, age, national origin, citizenship status, marital status, military/veteran status, genetic information, sexual orientation, gender identity, physical or mental disability or any other characteristic protected by applicable laws. Genpact is committed to creating a dynamic work environment that values respect and integrity, customer focus, and innovation. Get to know us at genpact.com and on LinkedIn, X, YouTube, and Facebook. Furthermore, please do note that Genpact does not charge fees to process job applications and applicants are not required to pay to participate in our hiring process in any other way. Examples of such scams include purchasing a %27starter kit,%27 paying to apply, or purchasing equipment or training.

About this role: Wells Fargo is seeking a Lead Fraud & Claims Operations Representative. In this role, you will: Support performance and overall effectiveness of team as well as cross-group operational tasks Proactively provide feedback and present ideas for improving or implementing processes and tools with efficient flow of fraud and claims operations Perform or guide others on complex account activity and claims that can include high risk and high dollar transactions requiring research that involves multiple transaction channels and products Independently prioritize work and provide day-to-day work leadership and mentorship for fraud and claims team Contribute in resolving control deficiencies in bank processes, procedures, customer, or team decisions that require coordination among cross-functional teams Provide guidance and subject matter expertise to less experienced staff in complex situations on wide range of information related to fraud and claims Required Qualifications: 2+ years of customer service, financial services, fraud, or investigations experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education Desired Qualifications: Good experience in fraud checks and investigations Good in excel reporting

In this role, you will: Supervise a team of specialists within a fraud and claims program for proactive fraud identification, prevention, and detection, as well as ensuring the recovery, execution, and handling of claims Identify opportunities for process improvement and risk control development in fraud and claims management to maximize efficiency and enhance customer service Make supervisory decisions and resolve issues related to work distribution under direction of fraud and claims management Leverage interpretation of internal processes and procedures to establish performance standards, evaluate performance, develop training materials, and ensure compliance with internal policies, risk controls, and government regulations Collaborate and consult with customers, vendors, and other functional areas to resolve escalated issues Interact directly with fraud and claims management to develop and implement functional area policies or procedures, and to provide exceptional customer experience Manage allocation of people and financial resources for Fraud and Claims Operations Mentor and guide talent development of direct reports and assist in hiring talent Required Qualifications: 2+ years of Financial Services, Fraud, or Investigation experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education Graduate or PG with 2+ years of experience in Backoffice Banking operation 1+ years Leadership experience Ability to manage a team of 15 and above Excellent verbal, written, and interpersonal communication skills Ability to facilitate new learning to staff as information, systems, and processes change Ability to assess issues, make quick decisions, implement solutions, and influence change Ability to work effectively in a team environment and across all organizational levels, where flexibility, collaboration, and adaptability are important Excellent knowledge on MS Office (Power point, Excel)

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative. In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers. Required Qualifications: 6+ months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education Desired Qualification: Reviews, verifies and/or identifies customer transactions to detect/prevent fraud, policy violations or resolve merchant disputes to mitigate and/or recover losses responsible for multiple claim types. Monitors and reviews complex account activity requiring research that may involve multiple transaction channels and products to reach resolution using multiple systems and applications Should possess basic banking knowledge and ability to analyze, investigate debit card disputed claims Receive direction from team lead and escalate questions and issues to more experienced roles Perform in-depth reviews of monetary and non-monetary transactions, and resolve customer disputes Reviews, verifies and/or identifies customer transactions to detect/prevent fraud, policy violations or resolve merchant disputes to mitigate and/or recover losses responsible for multiple claim types. Monitors and reviews complex account activity requiring research that may involve multiple transaction channels and products to reach resolution using multiple systems and applications Should possess basic banking knowledge and ability to analyze, investigate debit card disputed claims Receive direction from team lead and escalate questions and issues to more experienced roles Perform in-depth reviews of monetary and non-monetary transactions, and resolve customer disputes. University degree in Business or related discipline experience in chargebacks or cards operations Knowledge in Debit and Credit cards Strong analytical skills Good communication skills Job Expectations: Shift Timing: Rotational Shifts (US Holiday).

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative. In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers. Required Qualifications: 6+ months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education.

In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers Required Qualifications: 6+ months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education

About this role: Wells Fargo is seeking a Fraud & Claims Operations Representative. In this role, you will: Support fraud and claims functional area by proactively identifying opportunities to improve customer experience, and offer ideas to mitigate risks through effective authentication of customers in order to prevent fraudulent activity Perform moderately complex customer support tasks by utilizing solid communication, and verbal and written skills to establish rapport with customer and to deescalate difficult, as well as sensitive information as a part of resolving a claim Oversee multiple claim types, take appropriate action to decision the case using multiple systems and applications, and may contact third parties for research, as needed Receive direction from supervisor and escalate questions or issues Interact with immediate team and functional area on wider range of information, plus internal or external customers Required Qualifications: 1+ years of Customer Service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education Desired Qualifications: Should have knowledge in Debit Credit cards, Regulation E guidelines, US banking regulations. Ability to work additional hours if required. Must work on-site at the location posted. Must be flexible to work in multiple shifts Knowledge in Debit and Credit cards Strong analytical skills Good communication skills Job Expectations: Must be able to attend full duration of required training period Ability to work additional hours as needed Must work on-site at the location posted Shift Timing: 8:30 pm to 5:30 am IST (US Holiday)

About this role: Wells Fargo is seeking a Senior Fraud & Claims Operations Representative . In this role, you will: Support fraud and claims functional area by proactively identifying opportunities to improve customer experience, and offer ideas to mitigate risks through effective authentication of customers in order to detect and prevent fraudulent activity Perform complex customer support tasks by utilizing solid communication (inbound and outbound), verbal and written, skills to establish rapport with customer and to deescalate difficult, as well as sensitive information researched as a part of resolving a claim Oversee multiple claim types, take appropriate action to decision the case using multiple systems and applications, and may contact third parties for research, as needed Support team performance in identifying gaps in bank processes, procedures, customer, or colleague decisions Provide feedback and present ideas for improving or implementing processes and tools within fraud and claims functional area Provide subject matter knowledge and interpretation of procedures to less experienced staff Interact with fraud and claims functional area on a wide range of information as well as with external customers Required Qualifications: 18+ months of Customer Service, Financial Services, Fraud, or Investigations experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education Desired Qualifications: Experience in Quality Assurance process for Fraud & Claims Management. Should have wide knowledge in US banking regulations and guidelines. Should have knowledge on Debit/Credit cards, Fraudulent transactions, Risk monitoring. Advanced Microsoft Office skills. Ability to research and correspond with customers, probe with follow up questions respond to their concerns with detailed information. Ability to prioritize and meet deadlines. Good verbal, written, and interpersonal communication skills. Ability to compose clear, concise e-mails to a wide audience. Ability to navigate multiple computer systems, applications, and utilize search tools to find information. Excellent analytical skills with high attention to detail and accuracy. Ability to read correspondence accurately and be able to provide a written response. Ability to achieve high production and quality standards. Job Expectations: Must be able to attend full duration of required training period Ability to work additional hours as needed Must work on-site at the location posted Shift Timing: 8:30 pm to 5:30 am IST (US Holiday)

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative. In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers Required Qualifications, 6+ months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education

About this role: Wells Fargo is seeking a Associate Fraud & Claims Operations Representative. In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers Required Qualifications: 6 months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education

In this role, you will: Support fraud and claims functional area by proactively identifying opportunities to improve customer experience, and offer ideas to mitigate risks through effective authentication of customers in order to prevent fraudulent activity Perform moderately complex customer support tasks by utilizing solid communication, and verbal and written skills to establish rapport with customer and to deescalate difficult, as well as sensitive information as a part of resolving a claim Oversee multiple claim types, take appropriate action to decision the case using multiple systems and applications, and may contact third parties for research, as needed Receive direction from supervisor and escalate questions or issues Interact with immediate team and functional area on wider range of information, plus internal or external customers Required Qualifications: 1+ years of Customer Service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education Job Expectations: Must be able to attend full duration of required training period Ability to work additional hours as needed Must work on-site at the location posted Must be flexible to work on weekends Must be flexible to work in multiple shifts

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers Required Qualifications: 6+ months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education

Provides clinical review expertise for high dollar and complex claims, including facility and professional bills. Provides cost containment services by identifying coding and billing errors and insuring application of Medical and Reimbursement Policies. Additionally identifies cases for potential fraud and abuse and makes referrals. Major Job Responsibilities Evaluates medical information against criteria, benefit plan, coverage policies and determines necessity for procedure and refers to Medical Director if criteria are not met Evaluate itemized bills against reimbursement policies Adheres to quality assurance standards Serves as a resource to facilitate understanding of products Handles some escalated cases; secures supervisory assistance with problem solving and decision making Advises supervisory staff of any concerns or complaints expressed by Health Care Professionals Utilizes effective communication, courtesy and professionalism in all interactions, both internally and externally Performs additional unit duties below as appropriate: Participate on special projects. Perform random or focused reviews as required. Support and assist with training and precepting as required Analyze clinical information Perform claim reviews with focus on coding and billing errors Identify and refer cases for possible fraud/abuse or questionable billing practices to the appropriate matrix partners Handle multiple products and benefit plans Works under moderate direct supervision. Qualifications MBBS. Maintain active Medical as required by state and company guidelines Clinical experience in hospital/clinic for 3 or more years Team player Flexible/Adaptable Excellent time management, organizational, and research skills Experience with MS Office Suite (Outlook, Excel, Access, SharePoint) Preferred Qualifications Utilization Review or Claim Review experience in Health insurance Knowledge of the Principles of Health Care Reimbursement Key Skills and Competencies Strong background in quantitative decision making, ability to drive business/operations metrics Metrics-driven. Able to translate strategy into measurable operational goals and objectives. Disciplined in assessing performance and addressing problems. Good communication and strong interpersonal skills. Highly organized, structured & proactive. Good inter-cultural skills & Exposure to global work environment. Good time management skills - meet tight timelines and manage ad hoc deliverables, if any.

Full Time Opportunity Location: Goa/Kolkata/Patna/Assam/Jharkhand/Jamshedpur Job Description: - As a claim processing executive you will be responsible for handling all claim related activities on day today basis. - Checking all documents submitted by customers. - Verification of all documents with doctors, hospitals to cross check them for further process. - Coordination with customer if any document is missing or fake. Mentioning remark on every documents. - Coordination with head office to submit claim reports. - Coordination with branch head and other managers for smooth work process. - Maintaining MIS report on daily basis Qualification : MBBS, BAMS, BHMS Experience : 2 to 10 years in health insurance claim processing.