Manager/Senior Manager - Individual Death Claims

Shriram Life Insurance; Hyderabad; On-site; INR 2,800,000 - 4,200,000; Full time

Job summary

Shriram Life Insurance seeks a Manager/Senior Manager for Individual Death Claims to lead end-to-end adjudication, ensure compliance with IRDAI guidelines, and drive process improvements. The role includes risk assessment, regulatory adherence, and coordinating with internal and external stakeholders.

The ideal candidate will have 5–12+ years in life insurance claims, strong analytical skills, and a proven ability to manage teams and complex cases within DOA limits.

Qualifications

• Bachelor's degree in Business, Finance, or a related field.
• Senior Manager role requires 8-12+ years of life insurance claims experience, including death claims.
• Manager role requires 5-8 years of life insurance claims experience.
• Knowledge of IRDAI claim settlement regulations and fraud/investigation protocols.
• Strong analytical, decision-making and stakeholder management skills.

Responsibilities

• Own end-to-end adjudication of individual death claims settlement, repudiation, or partial payment within DOA and liability bands.
• Review medical, financial, and policy documentation to arrive at claim decisions per policy terms and IRDAI guidelines.
• Escalate high sum-assured, complex, or contentious cases with clear recommendations.
• Ensure claims processing adheres to regulatory and internal TAT norms.
• Identify early death claims and warrant investigation when necessary.
• Coordinate with investigators, medical referees, and legal counsel on high-risk claims.
• Lead and mentor the individual death claims team as SPOC for escalations.
• Maintain audit-ready records for internal, statutory, and reinsurance audits.
• Track settlement ratios and prepare monthly/quarterly MIS with accounts/finance.

Education

Bachelor's degree in Business, Finance, or a related field

Professional insurance qualification (e.g., III/Fellowship)

Job description

Job Description:

Manager / Senior Manager Individual Death Claims

Role-Specific Responsibilities within Life Insurance Individual Death Claims

Key Responsibilities

Claims Adjudication & Decision-Making

• Own end-to-end adjudication of individual death claims settlement, repudiation, or partial payment — within assigned Delegation of Authority (DOA) and liability bands.


• Review medical, financial, and policy documentation to arrive at claim decisions in line with policy terms and IRDAI guidelines.


• Escalate high sum-assured, complex, or contentious cases to the next level of authority with a clear recommendation.


• Ensure claims are processed within regulatory and internal turnaround time (TAT) norms.

Investigation & Risk Containment

• Identify early death claims (typically within 3 years of policy commencement/revival) and warrant for investigation if necessary.


• Evaluate investigation findings and apply Section 45 provisions in cases of suspected misrepresentation, non-disclosure, or fraud.


• Coordinate with RCU, empanelled investigators, medical referees, and legal counsel on suspicious or high-risk claims.


• Approve repudiation/void ab initio decisions with legally sound rationale and complete documentary evidence.

Team Leadership & SPOC Management

• Lead and mentor the individual death claims team, allocating cases by sum assured band and complexity.


• Act as Single Point of Contact (SPOC) for escalations from branches, Channels and the grievance redressal cell.


• Build team capability on medical underwriting nuances, documentation checks, and fraud‑indicator recognition.

Compliance & Audit Readiness

• Ensure claims processing adheres to IRDAI claim settlement regulations and the internal claims manual/SOPs.


• Maintain audit‑ready records — NOP (Notice of Proceeding), DOA approvals, and claim files — for internal, statutory, and reinsurance audits.


• Monitor and control the repudiation ratio, ensuring every repudiation letter is legally vetted and defensible.

MIS, Reporting & Reconciliation

• Track and report settlement ratio (by amount and by number of claims) against organizational targets.


• Prepare monthly, quarterly, and annual claims MIS — including BAP and authority reports — reconciled with the accounts/finance team.


• Present settlement/repudiation trend analysis and improvement insights at senior management and executive forums.

Process Improvement & Automation

• Drive automation and proactive‑identification initiatives — such as death registry/API integrations — to shorten claim intimation-to-settlement cycles.


• Identify process bottlenecks and lead initiatives to improve settlement ratio, reduce repudiations, and enhance turnaround time.

Stakeholder & Customer Engagement

• Engage with nominees/beneficiaries with empathy, keeping them informed of claim status and any pending requirements.


• Liaise with reinsurers on large sum‑assured claims as per treaty terms and reporting timelines.


• Coordinate with Underwriting, Legal, and Operations to resolve policy or documentation ambiguities affecting claim decisions.

Business & Sales Interface

• Interact frequently with Sales Heads and Zonal Heads to review claims pendency, TAT, and settlement performance for their respective zones/channels.


• Share regular and emerging claim trends, fraud patterns, and repudiation drivers with business teams to enable proactive course correction at the point of sale.


• Conduct real‑time/ongoing analysis of claims data to flag anomalies, channel‑wise risk concentration, and early warning signals to business and risk stakeholders.


• Partner with Sales and Zonal leadership on persistency, mis‑selling, and early‑claim patterns emerging from specific branches, agents, or channels.

Strategy, Automation & Systems

• Drive strategic initiatives to identify and close system/process gaps, improving straight‑through processing and reducing manual intervention.


• Lead automation and digitization efforts across the claims value chain, in coordination with IT and vendors.


• Participate in User Acceptance Testing (UAT) for new claims systems, product launches, and process changes, ensuring claims workability before go‑live.


• Maintain strong product knowledge across the life insurance portfolio to correctly interpret exclusions, waiting periods, and rider conditions during claim adjudication.

Audit, Escalations & Complaints

• Handle internal, statutory, and reinsurance audits for the death claims function, ensuring timely closure of observations and audit queries.


• Anticipate potential escalations and complaints proactively, putting preventive controls in place rather than only reacting to issues.


• Handle claim complaints and escalations end‑to‑end, including those from IRDAI, Ombudsman, and other regulatory/grievance forums.


• Extend help‑desk style support to internal stakeholders, branches, and channel partners for claim‑related queries, ensuring quick and accurate resolution.


• Think ahead on the way forward for the function — anticipating regulatory, business, or volume changes and preparing the team and processes accordingly.

Qualifications

• Bachelor's degree in Business, Finance, or a related field; a professional insurance qualification (e.g., III/Fellowship) is an added advantage.


• Manager: 5-8 years of experience in life insurance claims, with hands‑on exposure to individual death claims.


• Senior Manager: 8-12+ years of experience, including proven experience leading a death claims/RCU function.


• Sound working knowledge of Section 45, IRDAI claim settlement regulations, and fraud/investigation protocols.


• Strong analytical, decision‑making, and stakeholder management skills, with the ability to work under regulatory and TAT pressure.