Senior Manager - Health Claims Services

JOB PROFILE Department | Retail Business Group | Function | Retail & Legal Claims | Position | Health Claims - Trainer | Band | M1 | Location | Mumbai | Reporting To | JVP | Our Vision | To be the most admired insurance company that enables the continued progress of customers by being responsive to their needs. | HDFC ERGO as an Employer | - We believe in Sensitivity - We drive Excellence - We uphold Ethics - We bring Dynamism | About HDFC ERGO General Insurance Co. Ltd. | HDFC ERGO General Insurance Company Limited was promoted by erstwhile Housing Development Finance Corporation Ltd. (HDFC), India’s premier Housing Finance Institution and ERGO International AG, the primary insurance entity of Munich Re Group. Consequent to the implementation of the Scheme of Amalgamation of HDFC with and into HDFC Bank Limited , one of India’s leading private sector bank (Bank), the Company has become a subsidiary of the Bank. The Company offers complete range of general insurance products ranging from motor , health , travel , home and personal accident in the retail space and products like property , marine and liability insurance in the corporate space. With a network of branches spread across wide distribution network and a 24x7 support team , the Company has been offering seamless customer service and innovative products to its customers. | Key Roles & Responsibilities | Training Strategy & Delivery - Lead the design and execution of process training, soft skills training,medical traning and product refreshers for new and existing claims adjudicators - Conduct Training Needs Analysis (TNA) based on performance trends, quality results, and feedback from operations. - Ensure new hires receive effective onboarding, process knowledge, and certification before going live. - Partner with operations and product teams to update training content whenever processes, systems, or policies change. Quality Monitoring & Process Compliance - Monitoring to ensure adherence to quality standards and process guidelines. - Ensure sampling, scoring, and feedback processes are conducted consistently and within defined timelines. - Identify error trends, non-compliance issues, and skill gaps; drive corrective actions with supervisors and team leaders. - Improve Error rates- financial and non financial, compliance. Process Improvement & Customer Experience - Conduct RCA (Root Cause Analysis) for performance or quality gaps and drive action plans - Implement process improvements that reduce errors, AHT, repeat calls, and customer complaints. - Conduct regular calibration sessions with operations, vendor partners (if any), and leadership teams to ensure alignment on quality standards. Performance Reporting - Prepare and publish weekly and monthly MIS on training effectiveness, quality scores, error trends, and process compliance. - Present insights to leadership and recommend actionable improvements. - Maintain audit readiness through proper documentation, sample management, and corrective actions | Key Requirements – Education & Certification | - Doctor’s Degree Mandatory - 5–8 years of experience in training, quality, or process excellence - Prior experience in team handling or leading training/quality functions is preferred | Key Requirements – Experience & Skills | - Good understanding of medical Terminologies and insurance Terminologies | Remarks | The details of this position are confidential. The decision to change/modify the specifications is at management’s discretion. |