Team Member - Claims at Aditya Birla Capital

Job Overview

The role involves detailed understanding and management of claims processes across various insurance products including Indemnity (Cashless and Reimbursement) and Fixed Benefit products. This position demands familiarity with claims system workflows and fields relevant to Health, Personal Accident, and Travel insurance claims.

Key Responsibilities

• Monitor and evaluate team performance metrics such as turnaround time (TAT) and claims adjudication accuracy.
• Manage expectations and operational timelines for the claims processing team, including specialized business segments.
• Maintain consistent quality and adherence to turnaround times for claims decisions.
• Develop and uphold standard protocols and benchmarks for the claims team.
• Conduct audits of claims decisions to ensure compliance with guidelines, consistency in judgment, and adherence to approval authority limits across both in-house and third-party administrator (TPA) claims.