Key deliverables : The person will be responsible for delivering:
1. Adjudication of Claims & Claims related activities on regular basis:
High service delivery related to Claims management
Responsible for Scrutiny of claim documents and adjudication of all Life and Health insurance claim.
Responsible for preparing maintaining data for Monthly Reinsurance, Actuarial, and IRDAI Reporting.
Timely updating of Process manuals
Familiar with core Policy Administration System (PAS) such as Life Asia/ Integral Life
UAT for new products and enhancements from Claims perspective
Timely tracking of Pending cases and follow-up with various customers touch points like branches, agents/advisors.
Ensure Turnaround Time (TAT) is maintained for all activities as per IRDAI guidelines and internal TATs as set by function.
Analyze & understand medical terminologies.
Liaison with Underwriters and Reinsurers for re-underwriting of claims and seeking reinsurance opinion.
Investigator / Vendor management.
Understand Claims System and its core functionalities, track defects and reporting, development of new tools.
Preparation of test cases for claims UAT, testing cases and implementation.
2. Be able to actively contribute to the Claims Strategy and its implementation & monitoring at regular intervals. Hence be able to contribute and participate in the audits by IRDAI, Reinsurer, and all Internal / External Audits
3. To contribute in the training of junior claims assessors and any other internal stakeholder if required.
Publish Claims MIS to internal departments to reflect control & maintenance on the SLAs.
Take regular inventory of cases pending for requirements and taking appropriate decisions.
Call centre support: Support the call centre with the information desired for query resolution & Claim status.
Reporting structure : This person will report to the VP- Claims.
Key relationships : Sales, Operations, Products, Actuarial, Finance, Re-insurer, Legal.
Qualification and experience: Any Graduate or Post Graduate. Preferably a Licentiate or Associate of III, with at least 2- 4 years of work experience in Life/ Health Insurance Claims role. Pursing any other insurance qualifications would be preferential.
Key functional competency: Knowledge of basic Life/ Health insurance claims essential. Exposure to insurance trainings /workshops would be an added advantage.
Salary: INR Best In the Industry
Industry:Banking / Financial Services / Broking
Functional Area:Accounts, Finance, Tax, Company Secretary, Audit
Employment Type:Permanent Job, Full Time
Desired Candidate Profile
DHFL Pramarica Life Insurance Company
The combination of the strength of the DLF brand and PFI's insurance expertise provide the strongest possible foundations for DPLI to succeed in the rapidly growing Indian life insurance market.
PFI is a U.S. based financial services leader with its headquarters in Newark, New Jersey, with approximately USD 580 billion of assets under management as of June 30, 2009, and operations in the United States, Asia, Europe, and Latin America. Leveraging its heritage of life insurance and asset management expertise, PFI is focused on helping approximately 50 million individual and institutional customers grow and protect their wealth.
Contact Company:DHFL Pramarica Life Insurance Company