Posted:1 month ago| Platform: Linkedin logo

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Skills Required

compliance drive technology automation efficiency regulations audit reporting underwriting leadership coding cpt assessment billing management ocr workflow ai ml connect

Work Mode

On-site

Job Type

Full Time

Job Description

The role is with a leading General Insurance company.


About the Role

The organization is seeking a seasoned Head of Claims to lead its Health Insurance Claims function. The role focuses on driving operational excellence, regulatory compliance, and digital transformation across the claims lifecycle.


Responsibilities

  • Lead and enhance claims systems, rule engines, and automated workflows.
  • Oversee end-to-end claims operations—from intimation to settlement.
  • Guide resolution of complex and high-value claims.
  • Drive technology adoption, process automation, and efficiency improvements.
  • Ensure full compliance with IRDAI regulations and audit requirements.
  • Monitor KPIs, claims performance, and regulatory reporting (IRDAI/IIB).
  • Collaborate with underwriting, legal, product, IT, TPAs, and hospitals.
  • Manage escalations and ensure superior customer experience.


Qualifications

  • 10+ years of health insurance claims experience, with strong leadership exposure.


Required Skills

  • Expertise in medical coding (ICD-10, CPT), claims assessment, and billing processes.
  • Proven ability to work with claims management systems, automation tools, OCR, RPA, workflow engines, or AI/ML-led solutions.
  • Strong analytical, decision-making, and stakeholder management skills.


If you are interested for the same then connect with saloni@rightmatch.co.in - linkedin.com/in/salonikamdar

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