953 Claims Specialist jobs in India

Job Description

Industry: General Insurance / Insurance Broking / Insurance Surveyor

Location: Mumbai

Experience: 12+ years

Reporting To: Business Head/Vertical Head

Role Summary

The role holder will lead the claims function across all Specialty lines of business, ensuring efficient, compliant, and client-centric claims handling. The role involves strategic overview, operational excellence, and stakeholder management to drive timely and fair claim settlements.

Key Responsibilities

Strategic Leadership

• Define and implement claims strategy aligned with business goals.
• Lead and mentor a team of claims professionals.

Claims Operations

• Oversee end-to-end claims lifecycle across Specialty Claims like BBB, Cyber, Cards, Specie, Professional Indemnity, CGL, Event Cancellation, Loss of Fees, Media and Affinity.
• Ensure timely documentation, coordination with clients, insurers, surveyors, and regular client updates.

Client & Stakeholder Management

• Act as escalation point for complex or high-value claims.
• Maintain strong relationships with insurers, surveyors, and clients.

Compliance & Governance

• Ensure adherence to IRDAI regulations and internal SOPs.
• Handle audits, regulatory reporting, and internal risk controls.

Process Improvement

• Drive automation, analytics, and process optimization.
• Implement feedback loops for continuous improvement.

Candidate Profile

Education: Graduate/Postgraduate (Insurance certifications like Associate/Fellow from Insurance Institute of India preferred).

Experience: Minimum 12 years in claims handling, preferably in Insurance broking, PSU/Private insurance company, Insurance Surveyors operations.

Skills:

• Strong leadership and communication.
• Deep understanding of commercial insurance products.
• Ability to manage high-pressure situations and multiple stakeholders.
• Should be able to train the team members and improve their skills.

About GrayQuest

GrayQuest is India’s leading FinTech innovator in the education ecosystem, transforming the

$100B+ education industry through its cutting-edge financial solutions. Our flagship offering—

monthly EMI solutions for school and college fee payments—makes education more accessible,

affordable, and rewarding for millions of Indian families.

We partner with 5,000+ top educational institutions across the country, making us a trusted

name in education-focused financial services. Backed by some of India’s most respected

investors and entrepreneurs—including Kunal Shah & Miten Sampat (CRED), Nitin Gupta (UNI),

Sumit Maniyar (Rupeek), and Sujeet Kumar (Udaan)—we are now entering an exciting new Phase.

As part of our strategic expansion, we’ve launched a new insurance vertical focused on

providing customised life and health insurance products to families within our network and

beyond. This is a high-impact opportunity to be at the forefront of building this vertical from the

ground up.

Role Overview

We are seeking an experienced Health Insurance Claims Manager to oversee and manage the end-to-end claims process for our customers. In this role, you will serve as the primary liaison between clients, insurers, TPAs, and healthcare providers to ensure claims are handled smoothly, accurately, and on time.

The ideal candidate will have a strong background in health insurance claims management, excellent problem-solving skills, and the ability to deliver a seamless, customer-focused experience. This is a full-time, on-site role based in Mumbai with immediate joining.

Key Responsibilities

• Claims Processing & Adjudication: Manage the complete lifecycle of health insurance claims, including verification, documentation, submission, follow-up, and settlement.
• Customer Coordination: Assist and guide customers through the claims journey, ensuring forms and documents are accurate, complete, and submitted promptly.
• Insurance & TPA Liaison: Collaborate with insurers, third-party administrators (TPAs), and hospitals to ensure quick and accurate claim resolutions.
• Issue Resolution: Handle escalations, rejections, and disputes by investigating discrepancies, clarifying benefits, and negotiating fair outcomes for clients.
• Compliance & Accuracy: Ensure claims handling aligns with IRDAI guidelines, insurer protocols, and internal compliance standards.
• Monitoring & Reporting: Track claim turnaround times, analyze claim outcomes, and prepare periodic reports on performance and trends.
• Process Improvement: Identify inefficiencies in claims workflows and recommend process enhancements to improve speed, accuracy, and customer satisfaction.

Requirements

Education

• Bachelor’s degree in Business, Finance, Insurance, or related field.

Experience

• 3–6 years of proven experience in health insurance claims management or related roles.

Certifications

• IRDAI Health Insurance certification or equivalent preferred.

Skills

• Strong knowledge of health insurance policies, products, and claims procedures.
• Excellent communication, negotiation, and customer-handling skills.
• High attention to detail with strong analytical and problem-solving abilities.
• Proficiency in MS Office and claims management/CRM systems.

Attributes

• Customer-first mindset with empathy and professionalism.
• Ability to work under pressure and meet strict deadlines.
• Strong organizational skills and accountability.

Why Join Us?

Here’s why GrayQuest is different:

• Advice First, Always: We provide guidance, not pressure—helping families make confident decisions.
• Build Something New: Be part of creating a vertical from scratch at a fast-growing fintech.
• Trust & Transparency: IRDAI compliance, customer-first service, and honesty are non-negotiable.

• Conduct comprehensive investigations into assigned insurance claims.
• Gather and analyze evidence, including documentation, reports, and statements.
• Interview claimants, witnesses, and relevant parties to obtain information.
• Review insurance policies to determine coverage and applicable terms.
• Identify and investigate instances of potential fraud, misrepresentation, or abuse.
• Prepare detailed and accurate investigation reports with findings and recommendations.
• Collaborate with claims adjusters, legal teams, and other departments.
• Maintain thorough and organized case files.
• Ensure compliance with all relevant insurance laws and regulations.
• Testify in legal proceedings when required.

• Bachelor's degree in Criminal Justice, Business Administration, or a related field.
• Minimum of 3 years of experience in insurance claims investigation or a similar investigative role.
• Strong understanding of insurance principles, policies, and claims processes.
• Proven ability to conduct thorough investigations and gather evidence.
• Excellent interviewing and interpersonal skills.
• Strong analytical, critical thinking, and problem-solving abilities.
• Proficiency in claims management software and databases.
• Excellent written and verbal communication skills.
• Ability to work independently and manage time effectively.
• Familiarity with fraud detection techniques is a plus.
• Ability to work effectively in a hybrid remote and office-based environment.

• Receive, review, and process motor insurance claims from policyholders.
• Investigate assigned claims thoroughly, gathering necessary documentation such as police reports, repair estimates, and witness statements.
• Analyze policy coverage and conditions to determine the extent of liability and validity of claims.
• Assess vehicle damage, coordinate with repair shops, and evaluate repair estimates for accuracy and reasonableness.
• Negotiate settlements with claimants, policyholders, and third parties in a fair and efficient manner.
• Communicate effectively and empathetically with policyholders, providing updates and explanations throughout the claims process.
• Identify potential fraud indicators and escalate suspicious claims for further investigation.
• Ensure compliance with all company policies, procedures, and relevant insurance regulations.
• Maintain accurate and organized claim files within the claims management system.
• Liaise with garages, assessors, legal counsel, and other relevant parties as required.
• Manage claim timelines to ensure prompt resolution and customer satisfaction.
• Assist in the resolution of disputes or complaints related to claims.
• Stay informed about changes in motor insurance laws, regulations, and industry best practices.
• Contribute to the continuous improvement of claims handling processes.
• Provide exceptional customer service throughout the claims lifecycle.

• Bachelor's degree in Commerce, Business Administration, or a related field.
• Minimum of 3 years of experience in handling motor insurance claims.
• Solid understanding of motor vehicle insurance policies, terms, and conditions.
• Knowledge of vehicle damage assessment and repair processes is beneficial.
• Excellent analytical and problem-solving skills.
• Strong negotiation and communication abilities, both written and verbal.
• Proficiency in using claims management software and standard office applications.
• High degree of accuracy and attention to detail.
• Customer-centric approach with a commitment to providing excellent service.
• Ability to work independently and manage a caseload effectively.
• Adaptability to a remote work environment and strong self-discipline.
• Relevant insurance certifications are a plus.

• Manage and resolve assigned auto insurance claims from inception to closure, ensuring compliance with policy terms and regulatory requirements.
• Investigate accidents by gathering necessary documentation, reviewing police reports, and obtaining statements from claimants, witnesses, and third parties.
• Assess vehicle damage, obtain repair estimates, and negotiate fair settlements with policyholders, repair shops, and legal representatives.
• Determine coverage and liability based on policy provisions, state laws, and investigative findings.
• Maintain accurate and detailed claim files within the company's claims management system.
• Communicate proactively and professionally with policyholders, providing updates and explaining claim processes and decisions.
• Identify potential fraud indicators and escalate suspicious claims for further investigation.
• Collaborate with internal and external stakeholders, including adjusters, appraisers, and legal counsel.
• Stay informed about current trends, regulations, and best practices in the auto insurance claims industry.
• Provide guidance and mentorship to junior claims handlers as needed.

• Bachelor's degree in Business Administration, Finance, or a related field, or equivalent work experience.
• Minimum of 5 years of experience specifically in handling automobile insurance claims.
• Deep understanding of auto insurance policies, coverage types, and claims settlement procedures.
• Proven ability to investigate, evaluate, negotiate, and settle claims effectively.
• Excellent communication, interpersonal, and customer service skills.
• Strong analytical and problem-solving abilities with meticulous attention to detail.
• Proficiency in using claims management software and standard office applications.
• Ability to work independently, manage time effectively, and meet deadlines in a remote work environment.
• Relevant claims adjusting licenses and certifications are highly preferred.
• Experience with subrogation and salvage processes is an advantage.

• Investigate and evaluate medical malpractice claims, determining coverage and liability.
• Review and interpret complex medical records, legal documents, and expert reports.
• Conduct interviews with involved parties, including plaintiffs, defendants, witnesses, and healthcare professionals.
• Collaborate with internal and external legal counsel to develop defense strategies.
• Negotiate settlements within designated authority levels.
• Manage claim files with a high degree of accuracy and attention to detail.
• Provide regular status updates and reports to management and stakeholders.
• Ensure compliance with all relevant laws, regulations, and company policies.
• Identify and mitigate potential risks associated with claims.
• Stay current on medical advancements, legal precedents, and industry best practices in medical malpractice.

• Bachelor's degree in a related field; a law degree or paralegal certification is a significant advantage.
• Minimum of 5 years of experience in handling medical malpractice claims.
• Extensive knowledge of medical terminology, healthcare systems, and clinical practices.
• Strong understanding of legal principles related to medical malpractice.
• Exceptional analytical, critical thinking, and problem-solving skills.
• Excellent written and verbal communication skills, with the ability to articulate complex information clearly.
• Proficiency in claims management software and electronic medical record systems.
• Proven ability to work independently, manage a high-volume caseload, and meet deadlines in a remote environment.
• High level of integrity, professionalism, and ethical conduct.
• This role is based in Ahmedabad, Gujarat, IN but is fully remote.

• Investigate, evaluate, and negotiate insurance claims in accordance with policy coverage and legal requirements.
• Conduct thorough interviews with claimants, witnesses, and other parties involved in a claim.
• Gather and analyze evidence, including police reports, medical records, and repair estimates, to determine liability and damages.
• Communicate effectively with policyholders, claimants, and third parties to explain claim status, coverage, and settlement offers.
• Prepare detailed reports outlining claim findings, assessments, and recommendations.
• Negotiate settlements with claimants and legal representatives to resolve claims efficiently and fairly.
• Maintain accurate and up-to-date claim files and documentation within the claims management system.
• Identify potential fraudulent claims and escalate them for further investigation.
• Stay current with industry trends, regulatory changes, and best practices in claims handling.
• Provide exceptional customer service throughout the claims process.

• Bachelor's degree in Business Administration, Finance, or a related field.
• Proven experience as a Claims Adjuster or in a similar role within the insurance industry.
• Strong understanding of insurance policies, principles, and claims procedures.
• Excellent investigative, analytical, and problem-solving skills.
• Exceptional negotiation and communication abilities, both written and verbal.
• Proficiency in using claims management software and standard office applications.
• Ability to work independently and manage a caseload effectively.
• Valid driver's license and willingness to travel for claim investigations as needed.
• Knowledge of local and national insurance regulations.