Team Member - Claims

Job Purpose

This role is focused on supporting claims operations with strong knowledge of indemnity claims, including cashless and reimbursement cases, as well as fixed benefit products. The position requires familiarity with claims systems and end-to-end process flows across Health, Personal Accident (PA), and Travel lines.

Core Responsibilities

• Work confidently with claims processing for indemnity products, including cashless and reimbursement claims, along with fixed benefit offerings.
• Understand claims workflows and system fields used across Health, PA, and Travel claims operations.
• Track and improve performance metrics such as turnaround time (TAT) and accuracy in claims adjudication.
• Support expectation management for the claims team and specialized business handling.
• Help maintain consistent quality standards while ensuring claims are processed within defined TATs.
• Establish and sustain operating standards and protocols for the claims function.
• Review and audit claims decisions to ensure they align with guidelines, consistency requirements, and approval authority limits for both in-house and TPA claims.

Additional Information

This is a full-time, onsite position based in Maharashtra, India. The role requires a strong focus on process discipline, compliance, and decision consistency across claims operations.