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.

A notice, complaint, missed commitment or disputed amount opens a case.

People in the process

GGrievance RedressalProcess Owner
CClaimsParticipating Team
PPolicy OperationsParticipating Team
CCustomer ServiceParticipating Team

Records it works with

Relevant agreement, policy or governing record
Transaction, performance and payment history
Notices, communications and supporting evidence

The process is a starting point.The standards are yours.

Configure for the insurer, product, distribution model and applicable IRDAI requirements. Claims, underwriting, actuarial and grievance decisions stay with the authorised specialists.

Keep the work connected.

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.

GCE

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.

CSE

Explore all Insurance processes.

Order for the work. Room for the people.