Claims Manager - Health Insurance

HDFC ERGO General Insurance is one of India's leading private sector general insurance companies with a comprehensive portfolio covering Motor, Health, Travel, and Property insurance. With a customer base of over 25 million and a presence in 400+ cities, HDFC ERGO is known for innovation in insurance products and customer-centric claims settlement.

The Claims Manager will oversee health insurance claims operations for the Western region, managing claims processing worth ₹500+ crores annually while ensuring exceptional customer experience and regulatory compliance. This role combines technical insurance knowledge with operational leadership to balance claim settlement ratios, fraud prevention, and customer satisfaction.

• Manage end-to-end health insurance claims operations processing 50,000+ claims monthly across cashless and reimbursement categories
• Lead a team of 40+ claims assessors, investigators, and customer service specialists
• Ensure claims settlement within TAT commitments while maintaining fraud detection protocols
• Monitor claims settlement ratios, average claims cost, and operational efficiency metrics
• Collaborate with TPAs, network hospitals, and medical consultants for smooth claims authorization
• Handle escalations, litigation cases, and complex claim disputes requiring senior management intervention

• Bachelor's degree in Medicine (MBBS), Life Sciences, or related field; MBA in Healthcare/Insurance preferred
• 8+ years of experience in health insurance claims management with proven leadership track record
• Deep understanding of medical terminology, treatment protocols, and health insurance claim assessment
• Strong knowledge of IRDAI regulations, Insurance Act provisions, and consumer protection frameworks
• Experience with claims management systems, fraud detection tools, and data analytics platforms
• Excellent analytical and decision-making abilities with attention to detail
• Strong negotiation and stakeholder management skills for hospital network and TPA coordination

• Competitive package between ₹16L – ₹22L per annum
• Make meaningful impact by ensuring timely claims settlement for thousands of policyholders
• Work with India's fastest-growing private general insurance company
• Comprehensive benefits including group health insurance, performance incentives, and employee wellness programs
• Career growth opportunities across claims, underwriting, and business operations functions

This opening is not listed on any public job portal. It is a verified internal opportunity exclusively accessible through the website careerjump.co.in and directly apply to this job role. They also have similar job openings posted daily on their website. You can also join their WhatsApp Community for daily updates on verified internal job openings.