AM - Claims

Job Purpose

This role is focused on overseeing claims operations with a strong emphasis on accuracy, turnaround time, and consistent decision-making. The position requires hands-on understanding of indemnity-based claims such as cashless and reimbursement, along with fixed benefit products.

Core Responsibilities

• Work across claims workflows and understand how claim systems function, including key process steps and system fields for health, personal accident, and travel lines.
• Track and improve operational performance using measures such as turnaround time and accuracy in claims adjudication.
• Manage expectations effectively within the claims team and for specialized business handling.
• Help ensure claims decisions are handled uniformly while maintaining required turnaround times.
• Build and maintain clear standards and operating protocols for the claims team.
• Review and audit claims decisions to confirm alignment with claims guidelines, consistency in outcomes, and adherence to approval authority limits for both in-house and TPA claims.

Additional Information

This position requires a strong grasp of claims processes, operational discipline, and compliance-led review of claims outcomes.