AVP/Lead-Claims

Position: SM/AVP – SMART Claims 

Location: Noida

Job Type-Hybrid-3 days

Reporting: Head of Business Transformation/ Operations Unit - India

Position Overview: Lead the establishment and operations of a strategic Claims Support Center in Noida, driving 24/7 excellence in claims processing support for global BI/PD adjusters. This is a leadership role requiring a seasoned professional to build, mentor, and scale a high-performance team from ground up. 

Key Responsibilities 

Strategic Leadership:  

• Establish and operationalize the Claims Support Center within 90 days  
• Develop comprehensive operational procedures, quality standards, and performance metrics 
• Design and implement 24/7 shift operations including night shift (6 PM - 3 AM IST) 
• Create scalable processes to support global adjuster teams across multiple time zones 

Claims Process & Workflow Management 

• Ability to design, document, and continuously improve end-to-end claims workflows (FNOL to closure) to improve speed, quality, and cost. 
• Ability to define standard operating procedures (SOPs) and ensure adjusters and operations teams adhere to them. 
• Ability to monitor claims inventory and workload distribution, and recommend actions to balance capacity and meet SLAs. 
• Ability to identify bottlenecks or failure points in claims handling and propose practical process fixes. 

Core Analytical & Problem-Solving Skills 

• Strong ability to analyze claim patterns, exceptions, and outliers to detect potential fraud, leakage, or process gaps. 
• Ability to use data from multiple systems (claims platform, CRM, document management, billing) to form a holistic view of the claim. 
• Ability to prioritize and decide quickly in ambiguous situations, while staying aligned with guidelines and risk appetite. 

Quality, Compliance & Risk Management 

• Ability to ensure regulatory and internal compliance (documentation standards, privacy, fair claims handling, local regulations). 
• Ability to identify claim leakage (overpayments, missed recoveries, unnecessary expenses) and recommend preventative controls. 
• Ability to create/review checklists and guidelines to standardize proper documentation, reserves, and settlement practices. 

. Adjuster Support & Coaching 

• Ability to act as a subject matter expert and first point of escalation for adjusters on complex coverage or process questions. 
• Ability to coach and mentor TEAM on best practices, documentation quality, investigation standards, and negotiation strategies. 
• Ability to conduct training sessions on new products, processes, tools, and regulatory changes impacting claims. 
• Ability to communicate complex concepts in simple language, tailored to new joiners as well as experienced adjusters. 

Operational Excellence & Team Management 

• Build end-to-end claims support activities including documentation, investigation support, and stakeholder communication 
• Ensure compliance with regulatory requirements and company policies 
• Manage real-time support delivery to field adjusters 
• Drive process improvements and automation initiatives 

Stakeholder Management 

• Collaborate closely with BI/PD adjusters to understand support requirements 
• Coordinate with IT teams for technology integration and system optimization 
• Report to senior management on operational metrics and strategic initiatives 
• Ability to collaborate with cross-functional teams (Underwriting, Legal, SIU/Fraud, IT, Operations, Finance) to resolve claim issues. 
•  Ability to represent claims in projects and workshops, ensuring adjuster needs and customer impacts are clearly articulated. 
• Ability to influence without authority, driving adoption of new processes, tools, and behaviors across the claims team 

Required Qualifications 

Experience & Education 

• Minimum 14+ years in claims management with proven leadership experience 
• Bachelor's/Masters degree in Business, Finance, Insurance, or related field 
• Essential: Hands-on experience with BI (Bodily Injury) and PD (Property Damage) claims 

please share your resume at shobhana@futuristicuwltd.com