Manager
Future Generali Life Insurance Company Limited
Total years of experience :17 years, 10 Months
1. Claims assessment within the authority limits - Ordinary Life and Group Life.
2. Regulatory reporting and MIS to ensure compliance with regulatory requirements and management requirement.
3. Adherence to the regulatory guidelines pertaining to claims.
4. Work closely with the RCU team as to mitigate risk and strengthen underwriting guidelines.
5. Monitoring operational process documentation and suggesting improvement system wherever necessary; ensuring complete support to the alternate channel for their error free operations.
6. Guiding team in better understanding of processes, provide timely feedback to the team and develop team competence to achieve overall effectiveness / goals.
7. Investigator management with risk assessment from empanelment to payment.
8. Client visit, understanding the gaps and requirement.
9. Being Functional unit compliance officer (FUCO), performing risk and control of self-assessment (RCSA). Quarterly reviewed, identify risk, testing and check results
Reporting to : HOD - claims
Had joined the organization in 2005 as an executive.
Nature of Work
1. Claims assessment within the authority limits - Ordinary Life and Group Life.
2. Underwriting non medical policies
3. Monthly claims quality checks to ensure compliance with regulatory requirements
and company philosophy.
4. Meeting with management expectations by effective communication with seniors,
clients and stakeholders.
5. Co-ordination with IT team in developing an integrated Claims system to handle
claims processing, payout computation, requirements administration and monitoring.
6. Develop team competence to achieve overall effectiveness / goals.
7. Periodic improvement in SOP and processes as per business environment.
8. Management of TPA services, Investigators and Claim Records.
9. Data analysis - Early Warning Signs, productivity, live investigation and trends.
10. Field investigation.
11. Organizing training to Agent, Vendors and Channel Partners.
1. Manage the operations of Cashless mediclaims.
2. Assessment of Health Claims.
3. To assist fraud aspects & coordination with insurers.
4. Identifying potential claims problems and resolving it within TAT.
5. Review of MOU’s with service provider and monitors the SLA’s.
6. Attend external meetings as needed, for training and empanelment of hospitals as well as solving various issues of services providers with respect to claims.
7. Assessment of health claims.
8. Create timely MIS reports for management and analysis of claims data
1. Work involved handling all aspects of the Overseas Medi-claim Policy (OMP) i.e. from scrutinizing and processing all claim documents up to settlement.
2. Liasoning with International Claims Settling Agent (Mercury) - TPA to enable faster information retrieval for the benefit of the clients / insurers and monitor claims as and when reported.
3. Assist claimants in completing claim documentation.
Completed Licentiate and ongoing Associate
Masters in Computer Management
Bachelor of Commerce