Head of Claims

Job Purpose:

To lead and manage the claims operations of Guardian Life Insurance Ltd., ensuring efficient, complaint-focused service delivery while driving strategic improvements and cost optimization.

Key Responsibilities:

1. Develop and implement a strategic claims framework aligned with business goals and customer expectations.

2. Lead, mentor, and manage the claims team to ensure high performance, service excellence, and continuous development.

3. Drive operational efficiency by streamlining processes and ensuring timely, accurate claims settlement.

4. Ensure regulatory compliance with IDRA guidelines and internal policies across all claims operations.

5. Implement automation and digitization initiatives to enhance claims processing speed, accuracy, and scalability.

6. Deploy and manage GOP Service Facilitators at top hospitals and optimize GOP strategies for better provider engagement.

7. Strengthen fraud management systems by implementing robust detection, prevention, and investigation mechanisms.

8. Foster empathetic and transparent communication with claimants and beneficiaries throughout the claims lifecycle.

9. Collaborate with hospitals, TPAs, and service providers to ensure seamless medical claims processing and resolution.

10. Establish and monitor KPIs and MIS dashboards to track claims performance, ensure audit readiness, and support strategic decisions.