Responsible for the overall direction, governance, control, and management of Claims Operations for the organization. The role is focused on building a customer-centric, risk-aware, compliant, and future-ready Claims function that contributes significantly to business growth, customer trust, and organizational profitability. The position requires strategic leadership to drive operational excellence, industry-leading customer experience, risk management, digital transformation, and talent development while ensuring adherence to regulatory requirements and Company policies.
Key Responsibilities
- Formulate and drive the long-term strategy, objectives, and priorities for the Claims function in alignment with organizational goals and market dynamics
- Ensure effective governance and oversight of all claims decisions within the ambit of regulatory guidelines, industry practices, and Company policies.
- Lead engagement with Claims Council, industry forums, reinsurers, and regulatory bodies to influence and adopt best practices.
- Ensure effective management of high-value, complex, and sensitive claims cases.
- Drive prudent risk management in claims by effective assessment & investigation processes.
- Lead building of sound risk management practices by enabling experience analysis, feedbacks to distribution, participation in mortality management and product development.
Compliance with Regulatory guidelines
- Ensure adherence to all applicable IRDAI regulations, Insurance Act provisions, customer protection guidelines, grievance redressal requirements, and internal governance standards.
People Management
- Build and lead a highly engaged, capable, and customer-focused claims organization.
- Develop leadership pipelines, succession plans, and critical talent capabilities across the Claims function.
- Partner with HR to drive employee engagement, capability building, leadership development, retention, and recognition initiatives.
Measures of Success
- Industry-leading Claims Settlement Ratio and Claims Settlement TAT.
- Achievement of SLA and regulatory compliance requirements across all business lines.
- Strong audit ratings with timely closure of control gaps and regulatory observations.
- Effectiveness of engagements with Claims Council to deliver on key agendas.
- High level of distributor & customer satisfaction scores.
- Successful implementation of digital transformation and automation initiatives.
- Effectiveness of Change Management
Desired qualification and experience
- Post Graduate/MBA preferably in Law, Finance, Medicine or Insurance
- Strong technical knowledge of Life Insurance Claims, Risk Management, Regulatory Frameworks, and Reinsurance.
- Added qualifications from Insurance Institute of India, LOMA, ICA etc will be preferred.
- Professional certifications from LOMA, ICA, Insurance Institute of India, or equivalent institutions desired
- Minimum 15-18 years of relevant experience with significant leadership experience in Claims Management.
- Excellent business writing, presentation, stakeholder management, and negotiation skills.
- Experience in managing regulatory and industry-level interactions.