SM- Commercial claims - General Insurance- Chennai-12 lacs

Wego Consultants; Chennai District; Presencial; INR 1 200 000 - 1 800 000; Tempo integral

Resumo da oferta

Wego Consultants in Chennai, India, seeks a mature professional to lead general insurance claims operations. You will oversee end-to-end claim processing, ensure compliance with policy terms and SLAs, and guide a team of claims officers to deliver efficient resolutions.

Responsibilities include quality reviews, fraud risk awareness, stakeholder coordination, and MIS reporting to management. A strong background in claims procedures and IRDAI-regulated practices is essential.

Qualificações

• 5–10 years in general insurance claims, with supervisory experience.
• Graduate in any discipline; preferred: Law/Engineering/Insurance/Finance; professional qualifications advantageous.
• Strong knowledge of policy wordings, claims procedures, survey/loss adjusting practices, and local regulations.

Responsabilidades

• Oversee registration, assessment, processing and settlement of claims in line with policy terms and SLAs.
• Ensure claims are handled efficiently, accurately and within agreed turnaround times with proper documentation.
• Review and approve claims; escalate high-value or complex cases as per matrix.
• Interpret policy wordings to determine coverage and liaise with service providers for reports and repairs.
• Conduct root-cause analysis on complex claims and drive corrective actions in process.
• Lead and mentor a team; train on procedures, regulatory changes and soft skills.
• Coordinate with legal teams; publish periodic MIS on claims trends and performance.

Conhecimentos

Analytical skills

Decision making

Communication

Stakeholder management

People leadership

MS Excel/PowerPoint

MIS reporting

Formação académica

Bachelor's degree

III / CII professional insurance qualifications

Ferramentas

MS Excel

PowerPoint

Claims management systems

Descrição da oferta de emprego

Role & responsibilities

1. Claims Operations Management

• Oversee registration, assessment, processing and settlement of claims in line with policy terms, company guidelines and SLAs.
• Ensure claims are handled efficiently, accurately and within agreed turnaround times, with proper documentation and system updates.
• Review and approve claims within delegated authority; elevate highvalue, complex or disputed cases as per matrix.

1. Technical Assessment & Quality

• Interpret policy wordings, endorsements and exclusions to determine coverage and liability.
• Liaise with surveyors, loss adjusters, investigators, garages, hospitals and other service providers, ensuring quality and costeffective reports and repairs.
• Conduct rootcause analysis on complex or repeat claims issues and drive corrective actions in process or underwriting.

1. Customer Service & Dispute Resolution

• Handle escalated customer complaints and grievances related to claims; ensure fair, transparent and timely resolution.
• Communicate clearly with policyholders, intermediaries and partners on claim decisions, requirements and next steps.
• Support initiatives to improve customer satisfaction and Net Promoter Score (NPS) in claims.

1. Cost Control, Reserving & Fraud Management

• Monitor claim costs, reserves and leakage; ensure adequate reserving and timely revisions based on development of claims.
• Identify potential fraudulent or exaggerated claims, coordinate investigations, and recommend appropriate action.
• Provide inputs to reinsurance and finance teams on large losses, recoveries, subrogation and litigation exposure.

1. People Management & Process Improvement

• Lead and mentor a team of claims officers/executives; set targets, allocate workload, monitor performance and conduct regular reviews.
• Train team members on policy coverage, claims procedures, documentation standards, regulatory changes and soft skills.
• Continuously review and improve claims workflows, SOPs and systems to enhance efficiency, control and customer experience.

1. Compliance, Governance & Reporting

• Ensure adherence to IRDAI regulations, internal policies, audit requirements and company claims philosophy.
• Coordinate with legal teams and external counsel on litigated/critical matters; attend court as company representative where required.
• Prepare and publish periodic MIS and analytics on claims trends, TAT, repudiation, recovery, and portfolio performance for management review.

Preferred candidate profile

Qualifications & Experience

• Graduate in any discipline; preferred: Law / Engineering / Insurance / Finance; professional insurance qualifications (III / CII) added advantage.
• 5-10 years of experience in general insurance claims (motor / non-motor / health / property), with minimum 23 years in a supervisory / managerial role.
• Strong knowledge of policy wordings, claims procedures, survey/loss adjusting practices, and local insurance regulations.

Skills & Competencies

• Strong analytical and decisionmaking skills; ability to balance customer centricity with loss minimisation.
• Excellent communication, negotiation and stakeholder management skills (customers, intermediaries, surveyors, lawyers, internal teams).
• People leadership, coaching and performance management capabilities.
• Proficiency in claims management systems, MS Excel/PowerPoint and MIS/reporting.
• High integrity, attention to detail and ability to work under pressure with large case volumes.