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Forward Group
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Head - Control Claims

Head - Control Claims

8 - 10 years

|

30 - 35 Lacs

Posted:5 hours ago| Platform:

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Skills Required

Forensic Investigations Fraud Investigation Claim Investigation Fraud Detection Health Claims Insurance Claims IRDA Dispute Resolution Due Diligence Document Review

Work Mode

Work from Office

Job Type

Full Time

Job Description

Role & responsibilities

manage risk across claims and underwriting processes. This leadership role requires close collaboration with multiple internal teams, including Claims, FWA, Retail Underwriting, Sales and Actuarial departments, to drive business performance, ensure regulatory compliance, and maintain effective governance.
Monitor overall claims and underwriting portfolio performance by analyzing trends throughout Channels.
Collaborate with Channel Heads and ground teams to define actionable plans for addressing unproductive or loss-making claims segments, fraud identification and prevention; etc.
Lead initiatives to reduce claims costs, mitigate losses in unprofitable cohorts, and improve customer experience
Conduct process reviews to identify and control processing errors, transaction outliers, and implementation risks.
Develop and execute risk mitigation strategies to ensure smooth adoption of new processes and strategies.
Manage audits and resolve findings related to Claims and Underwriting, including IRDA, internal, statutory, and other audits.
Lead quality checks for processed claims (in-house and TPA) through concurrent/retrospective audits and system validation.
Conduct audits of NEFT/Payment processes and clinical coding to ensure accurate system adjudication and effective data analytics.
Enhance documentation and reporting accuracy within the Claims function.
Oversee governance within the Claims and Underwriting teams to align with company objectives.

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