Associate Senior Manager-Approval

1. Research and process improvements

• Continuously analyze existing internal processes, learn from external best practices and identify process efficiency gaps; Generate ideas, develop and lead implementation of process improvements in TP claim portfolio to be better manage TAT, quality and HO volumes (> INR 10 lac claims)
• Continuously analyze judicial trends, research ongoing judgements, changing claim size, etc. to assess impact on internal processes and future changes
• Estimate resource requirements considering current inflow, count of awards/ compromises, claim size, etc. and future judicial trends related to approval process, claim size, etc.
• Guide and provide inputs to the team on understanding/ interpreting new judgements, new cases / concepts, facts, etc.; Explore and seek opportunities to reduce the claims and ensure savings for the company

1. Line of action

• Supervise and oversee the recommendations on line of action i.e. compromise / defend or file appeal / pay; Ensure line is of action is based on precedents and liability is safe for the company
• Review cases, study various aspects and technicalities to recommend any angle that have been missed by the team or ILM, such as driving licenses related technicalities, etc.; Put up suggestions on documents/ evidence to be produced at the courts from company side
• Undertake deep analysis into technicalities such as loss of income, partial loss, loss of major organs, investigations, etc. to determine for huge liability cases and determine appropriate line of action and minimize loss

1. Reserving Management

• Oversee the processes for reserving management, ensuring timelines and adequate reserving for the reserving maintained by the regional approving authorities (INR 10 lac - 1 cr)
• Study and conduct initial scrutiny for the reserving for the HO cases (beyond 1 cr.); Determine reserving amount and discuss with Head Claims Legal for finalization as direct impact on the company financials

1. Approval

• Oversee and guide team in maintaining claim size and ensuring approvals are judicious and achieve savings for the company
• For claims exceeding INR 50 lacs, review and study the individual files to ensure various aspects are appropriate such as reserving, documentation, line of action, witnesses from company side to be examined, police authority investigations, etc.
• For other claims, in case of criticality or roadblocks, intervene in technical claims, frauds, etc. and provide technical inputs for resolution
• For close proximity cases, the policy issuance is 15 days prior to case, and genuine orphan claims such as fake policy, manipulated policy, etc., oversee such cases and put forth a view on line of action and next steps

1. Medical management

• Review and approve all letters of complaints to be filed against doctors involved in cases
• Guide the team in proposing line of action and ideas for action/ cross examination in cases involving injury, petitioners requiring to prove disability, etc.

1. Team development

• Participate in selection process to identify right talent for positions within the team
• Establish individual performance expectations and evaluation metrics, and regularly review individual performance

Identify and create development opportunities for team members to enhance domain knowledge