Head - Claims

The role is with a leading General Insurance company.

About the Role.

The organization is seeking a seasoned Head of Claims to lead its Health Insurance Claims function.

The role focuses on driving operational excellence, regulatory compliance, and digital transformation across the claims lifecycle.

Responsibilities:

- Lead and enhance claims systems, rule engines, and automated workflows.

- Oversee end-to-end claims operations-from intimation to settlement.

- Guide resolution of complex and high-value claims.

- Drive technology adoption, process automation, and efficiency improvements.

- Ensure full compliance with IRDAI regulations and audit requirements.

- Monitor KPIs, claims performance, and regulatory reporting (IRDAI/IIB).

- Collaborate with underwriting, legal, product, IT, TPAs, and hospitals.

- Manage escalations and ensure superior customer experience.

Qualifications:

- 10+ years of health insurance claims experience, with strong leadership exposure.

Required Skills:

- Expertise in medical coding (ICD-10, CPT), claims assessment, and billing processes.

- Proven ability to work with claims management systems, automation tools, OCR, RPA, workflow engines, or AI/ML-led solutions.

- Strong analytical, decision-making, and stakeholder management skills.