Assistant Manager - Retail Claims

Tata AIA Life Insurance; Thane; On-site; INR 900,000 - 1,300,000; Full time

Job summary

Tata AIA Life Insurance is seeking an Assistant Manager in the Retail Claims department to conduct quality checks on adjudicated death claims, validate benefits against policy terms and guidelines, and drive continuous improvements across the claims process.

The role requires strong analytical skills, risk awareness, and the ability to handle customer communications with empathy while ensuring timely and accurate claim resolutions in a regulated environment.

Qualifications

• Essential - Graduate
• Desiring MBBS, BHMS, BAMS
• Experience - 2-3 Years

Responsibilities

• Perform comprehensive quality checks on adjudicated death claims.
• Validate claim benefits against product features, policy terms and guidelines.
• Analyze trends and contribute to strengthening QC frameworks.
• Ensure adherence to internal, regulatory and audit requirements with timely delivery.
• Identify gaps and drive process improvements aligned with business objectives.
• Manage end-to-end processing of death claims with accuracy and transparency.
• Communicate with customers with clarity and empathy.
• Maintain data integrity and prepare reports on claims performance and governance.
• Address claims-related complaints and assist walk-ins with prompt resolutions.
• Apply claim assessment principles including verification of docs, underwriting aspects and fraud indicators.

Skills

Claims Processing

Regulatory reporting

Regulatory guidelines

Presentation skills

Communication skill

Interpersonal skills

Creative thinking

Teamwork

Decision making

Supervising/Leadership

Influencing skills

Relationship building

Education

Graduate

MBBS/BHMS/BAMS

Job description

A. Position Overview

Position Title - Assistant Manager

Department - Retail Claims

Level/ Band - 301

B. Role Summary

• Conduct comprehensive quality checks on all adjudicated death claims with a strong focus on risk identification and mitigation.
• Validate the accuracy of claim benefits in line with product features, policy terms, and internal guidelines.
• Analyze emerging trends and collaborate with internal stakeholders to strengthen the claim quality control framework.
• Ensure adherence to all internal, regulatory, and audit requirements while delivering outcomes within defined timelines.
• Identify process gaps, recommend improvements, and drive enhancement projects aligned with business objectives.
• Manage endtoend processing of all death claims, ensuring accuracy, transparency, and timely resolution.
• Handle all customer communications with clarity, empathy, and professionalism.
• Maintain data integrity and manage all reports related to claims performance and governance.
• Address claimsrelated complaints and assist walkin customers with prompt and effective resolutions.
• Apply strong claim assessment principles, including verification of documentation, assessment of medical and financial underwriting aspects, and evaluation of potential fraud indicators to ensure fair and just claim decisions.

C. Organizational Relationships

Reports to - Sr Manager - Claims

Supervises - NA

D. Job Dimensions

Geographic Area Covered - PAN -India

Stakeholders -

Internal - Finance,POS, underwriting team, Branch ops, RCU, IT, Customer Service, Legal & Compliance

External - External legal consultant, legal counsel, investigators, Claimants, Customers and Claim consultants

E. Key Result Areas

Organization Process

Key Contribution -

Claims QC

• Good knowledge of insurance & products & claim operations
• Ensure 100% quality checking of death claims to validate adherence to claim processes
• Impart training to assessment team based highlighting common lapses noted during daily QC.
• Ensure compliance with all internal & regulatory requirements and delivery in lines with the same.
• Regular update of QC checklist to ensure addition of new checkpoints and deletion of redundant checkpoints

Implement control measures for QC error reduction and ensuring correct claim payment

• Take measures necessary to reduce repetitive errors and improve overall Quality score
• Prepare control reports for proactive identification of process gaps
• Identify areas of improvement and liaise with internal stakeholders to take up automation projects for speedy resolution of process gaps and QC errors
• Conduct periodic internal audits for proactive identification of risk areas and process lapses

Manage all regulatory, compliance & audit requirements for claims team

• Manage process walkthrough and assist in query response
• Manage and prepare data for compliance, regulator and audit requirements for ensuring timely closure
• Conduct pre-audit reviews

F. Competencies

• Customer & Consumer Engagement and experience in a hybrid world -3
• Business Acumen and domain knowledge - 4
• Networking and collaboration- 3
• Change management- 3
• Developing managing & working with hybrid teams- 3
• Technology, Digital and analytics-3

G. Skills Required

Technical -

• Claims Processing.
• Sound knowledge of regulatory reporting, registrations.
• Regulatory guidelines.
• Presentation skills.
• Communication skill

Behavioral -

Essential

• Interpersonal skills
• Communication skills
• Creative thinking skills
• Teamwork Skills
• Decision making skills

Desired

• Supervising/Leadership skills
• Influencing skills
• Relationship Building skills

H. Incumbent Characteristics

Qualification

Essential - Graduate

Desired - MBBS, BHMS, BAMS

Experience - 2-3 Years