Manager- Claims & Servicing

Full Time | On Site
Janakpuri West, Delhi

Roles & Responsibilities

    About the Role

    RiskBirbal Insurance Broker Pvt. Ltd. is seeking an experienced and customer-focused Manager – Health Insurance, Accidental Insurance, Term Life Claims & Servicing to lead the  Department. The ideal candidate will be responsible for managing end-to-end claims, policy servicing operations, team performance, client satisfaction, and coordination with insurance companies and TPAs. The role requires strong leadership, excellent client relationship management, and in-depth knowledge of health insurance processes.

    Key Responsibilities

    ·       Lead and manage the Claims & Servicing team to ensure smooth daily operations.

    ·       Oversee end-to-end processing of reimbursement and cashless health insurance claims.

    ·       Coordinate with insurance companies, TPAs, hospitals, and clients for timely claim processing and settlement.

    ·       Monitor claim status, follow up on pending cases, and ensure closure within defined TAT.

    ·       Handle escalated customer queries, complaints, and complex claim cases with effective resolution.

    ·       Manage policy servicing activities, including endorsements, renewals support, policy corrections, additions, deletions, and policy-related requests.

    ·       Ensure complete and accurate claim documentation before submission to insurers or TPAs.

    ·       Maintain strong relationships with insurance companies, TPAs, hospitals, and corporate clients.

    ·       Monitor departmental KPIs, claim ageing, TAT, and service quality metrics.

    ·       Prepare daily, weekly, and monthly MIS reports and performance dashboards.

    ·       Ensure all claim and servicing activities are accurately updated in the CRM system.

    ·       Develop and implement SOPs to improve operational efficiency and customer experience.

    ·       Train, mentor, and evaluate team members to enhance productivity and service quality.

    ·       Coordinate with Sales, Operations, Accounts, and IT teams for seamless customer servicing.

    ·       Ensure compliance with IRDAI regulations, insurer guidelines, and company policies

Experience and Qualifications

    Required Skills

    ·       Strong knowledge of EB policies claims and policy servicing.

    ·       Good understanding of cashless and reimbursement claim processes.

    ·       Experience working with TPAs, hospitals, and health insurance companies.

    ·       Excellent leadership and team management skills.

    ·       Strong customer handling, negotiation, and grievance resolution abilities.

    ·       Advanced knowledge of MS Excel, MIS reporting, CRM systems, and operational reporting.

    ·       Excellent communication, analytical, and problem-solving skills.

    ·       Ability to manage multiple priorities and meet strict service timelines.

    Qualification

    ·        Bachelor's Degree in any discipline.

    ·        MBA/PGDM will be preferred.

    ·        Insurance certifications (III/Fellowship/Health Insurance-related certifications) will be an added advantage.

    Preferred Experience

    ·        5–10 years of relevant experience in Health Insurance Claims & Servicing with an Insurance Broker, Health Insurance Company, or TPA.

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