Role Objective: To review and process issued cases in accordance with terms and conditions of policy, internal SOP, regulatory guidelines.
Key Responsibilities:
- Initiate field investigation as per defined process
- Track and coordinate with OFRM Team on pending cases
- Review field investigation reports along with documents received at NB stage to identify any non-disclosure / misrepresentation of material facts or any other observations which can lead to a potential early claim
- Decisioning with proper justification by interpreting policy terms, underwriting guidelines and exclusions.
- Fraud identification and initiating actions for lodging police complaint / FIR’s on eligible cases
- Stakeholder and escalation management
- Inter department coordination
Measures of Performance:
- TAT adherence for processing cases
- Accuracy on decisions and audit outcomes
- Customer satisfaction
- Fraud detection effectiveness
- Stakeholder management
Eligibility Criteria:
- Graduate with required communication skills
- 3 years of experience in insurance claims (life insurance preferred)
- Familiarity with IRDAI regulations
Knowledge and skills required :
- Life Insurance domain knowledge
- Good understanding of life insurance products, nominations, early & non-early claim, pre-claims frameworks
- Good communication skills
- Good interpersonal skills
- MIS, MS Excel
Pay: ₹15,000.00 - ₹30,000.00 per month
Benefits:
- Health insurance
- Leave encashment
- Provident Fund
Work Location: In person
