Assistant Manager Claim Analyst & Litigation

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Responsibilities

Analyze incoming claim submissions to assess validity and compliance with policy terms.

Provide re-analysis results, recommendations, and make final decisions for claims within assigned authority limits.

Prepare all necessary documentation related to claim litigation processes.

Coordinate with relevant internal teams regarding received claim cases.

Collaborate with the Legal Team to respond to clarification requests and/or serve as a factual witness in claim decisions, including appearances in court, police investigations, or customer mediation sessions—both within and outside the city.

Maintain and regularly update reports on fraud cases, non-disclosure claims (NDC), mediation outcomes, and court decisions, including cost-saving analysis.

Qualifications

Educational Background: Minimum qualification as a Medical Doctor (MD) or a degree in Health Sciences, Nursing, Pharmacy, or Public Health.

Industry Experience: 5–7 years of professional experience exclusively in the life insurance industry, with a strong focus on claims and litigation.

Claims Expertise: Demonstrated expertise in handling both major and minor life insurance claims, including medical assessment, fraud detection, and policy compliance.

Litigation Handling: Proven experience in managing disputed life insurance claims, preparing legal documentation, and supporting legal teams in resolution processes.

Communication Skills: Excellent communication and negotiation skills for effective interaction with hospitals, legal teams, and internal departments.

Technical Proficiency: Proficient in claims management systems and digital documentation tools.

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