Head - Claims & Underwriting

Key Responsibilities

Claims Management:

- Supervise and lead the entire claims process, from initial notification to final settlement and disbursement.

- Ensure timely and accurate processing of both cashless and reimbursement claims, adhering to policy terms and regulatory guidelines.

- Resolve complex claim escalations and disputes, managing customer interactions to maintain satisfaction.

Underwriting Operations:

- Oversee the underwriting process for new and existing health insurance policies, assessing risks and determining appropriate coverage.

- Develop and implement underwriting policies and guidelines to ensure sound risk selection and pricing.

- Collaborate with actuarial and product development teams to refine underwriting strategies and support business growth.

Team Leadership:

- Manage and develop a team of claims and underwriting professionals, fostering a culture of high performance and continuous improvement.

- Provide training and guidance to the team on industry best practices, product knowledge, and regulatory requirements.

Strategic & Operational Oversight:

- Develop and execute strategies to improve efficiency, reduce processing times, and enhance customer experience in both claims and underwriting.

- Monitor key performance indicators (KPIs) and implement corrective actions to achieve organizational goals.

Regulatory Compliance:

- Ensure all claims and underwriting activities comply with relevant health insurance regulations and industry standards.

- Stay updated on changes in regulatory requirements and adapt processes accordingly.