Carry every claimto a clear outcome.

Claims

Resolve coverage questions before a claim decision

Reconstruct the operative policy schedule, endorsements, loss facts, exclusions and expert assessment. A claims specialist records the reasoned coverage position, tests contrary evidence and identifies what the policyholder still needs to supply.

Claims

Close hospital and TPA queries against treatment evidence

Link pre-authorisation, discharge summary, itemised bill and TPA or hospital queries to the relevant health cover. The claims officer resolves medical or policy questions with qualified reviewers so a patient receives a substantiated decision.

Claims

Turn surveyor findings into a defensible loss assessment

Connect the survey report, damage inventory, repairs, salvage and policy limits for a general-insurance loss. Claims staff resolve inconsistencies with the surveyor and document the approved settlement basis rather than treating an external estimate as the decision.

Claims

Carry an authorised claim to the right payee

After the claims decision, match settlement terms, beneficiary or hospital details, deductions and finance payment reference. Resolve rejected transfers or competing payee instructions before telling the policyholder the claim is paid.

Claims

Prioritise claims that need a specialist decision

Separate missing documents from coverage disputes, overdue external opinions and approved but unpaid claims across a handler’s caseload. The specialist can focus on the next substantive decision and give customers accurate case updates.

Policy Operations & Distribution

Catch a policy wording mismatch before issue

Compare the accepted proposal, underwriting quotation, schedule, exclusions and add-ons with the document queued for issue. Refer material differences to underwriting so the insured receives the cover actually approved and priced.

Policy Operations & Distribution

Trace an intermediary promise into policy servicing

When a broker or agent disputes cover, reconstruct the proposal, authorised quote, premium receipt, issued schedule and correspondence. Policy operations and underwriting decide the correction or explanation before the mismatch becomes a claim dispute.

Policy Operations & Distribution

Issue endorsements from an approved change record

Connect the insured’s requested change, effective date, underwriting conditions and premium adjustment. Policy operations verifies the final endorsement against the decision so mid-term cover and billing do not contradict each other.

Policy Operations & Distribution

Review commercial-policy renewal changes before quotation

For commercial property or liability cover, bring changed operations, risk-survey findings, broker disclosures and claims experience to the underwriter. Carry the approved terms into the renewal quotation so the offer reflects the risk being accepted.

Policy Operations & Distribution

Resolve channel premium and policy allocation exceptions

Match intermediary collection or insurer bank receipt to proposal, policy and allocation records; investigate reversals or unidentified amounts with finance and the channel. An authorised operator corrects records before cover status or customer communication is affected.

Grievances & Legal

Answer a complaint from the complete case history

Tie the customer’s allegation to issued terms, calls, claim reasoning, provider correspondence and payment events. The grievance officer decides the remedy or substantiated response and carries any underlying process failure to its owner.

Grievances & Legal

Build the record for an Ombudsman or consumer matter

Assemble the policy version, proposal, claim evidence, decisions and every customer response into a dated chronology. Counsel and the grievance officer review the position, authorities and possible remedy before a formal response.

Grievances & Legal

Find the cause behind repeated customer complaints

Group upheld complaints by wording, sales explanation, TPA query, branch or provider, then inspect representative files rather than relying on counts alone. A grievance specialist can form a defensible root-cause view for a subsequent corrective decision.

Grievances & Legal

Preserve a claim-related recovery case

For eligible general-insurance losses, join settlement evidence, third-party liability facts, repair records and contractual rights. Legal and recoveries staff decide whether to pursue a responsible party and maintain the supporting chain after paying the insured.

Reinsurance & Finance

Preserve notice and evidence for reinsurer recoveries

Relate a material loss to treaty or facultative cover, attachment, share, notice terms, claim updates and reinsurer correspondence. The reinsurance specialist confirms the ceded position and pursues a documented recovery after the insurer’s claim decision.

Reinsurance & Finance

Resolve a disputed reinsurer recovery amount

Compare ceded claim calculation, paid loss, deductibles, reinstatement and reinsurer statements. Reinsurance and finance staff explain variance, negotiate the supported amount and record the revised receivable without shifting the policyholder decision to the reinsurer.

Reinsurance & Finance

Explain claims movements before the finance close

Reconcile paid and outstanding claim records, recoveries and actuarial extracts to finance schedules; identify late updates or inconsistent case status. Claims and actuarial owners certify their inputs before finance books the reviewed position.

Reinsurance & Finance

Reconcile insurer returns across finance, claims and actuarial

Link the applicable return, reporting period and source schedules to finance, actuarial and claims sign-offs. Compliance resolves classification or version differences before authorised submission, retaining the filed copy and subsequent regulator queries.

Product, Compliance & Provider Oversight

Carry a product change into live operations

Connect approved wording and pricing decisions to policy documents, channel material, underwriting rules, claims guidance and market-specific filing route. Product owners review residual mismatches before launch and identify affected existing policies separately.

Product, Compliance & Provider Oversight

Approve a claims provider with workable controls

Bring TPA, surveyor or assistance-provider scope, credentials, data access, service standards and exit provisions into procurement and compliance review. Claims leadership accepts operational readiness before cases are assigned.

Product, Compliance & Provider Oversight

Turn provider failures into corrective action

Trace delayed cashless decisions, repeated document requests or poor survey quality to affected cases, contracted service levels and customer outcomes. Provider management agrees remediation with claims and checks whether customers need an immediate remedy.

Product, Compliance & Provider Oversight

Translate an IRDAI change into accountable work

Determine which insurer, product and effective period a circular addresses, then compare it with wording, customer notices, provider contracts and operating guidance. Compliance obtains specialist sign-off and proof that affected teams changed practice.