Team Member - Claim Control (Thane )

Basic Details: Fill the required information about business, unit, location, position, reports to position and date of updation of JD Business Financial Service - HO Unit Aditya Birla Health Insurance Company Ltd Location Thane Poornata Position Number of the job Reports to: Poornata Position Number Poornata Position Title of the job (30 characters max) Reports to: Poornata Position Title Function Services Operations Reports to: Function Financial Service Operations Department Ops - Claims Reports to: Department Ops - Claims Designation of the Employee Team Member Claims Control Designation of the Manager Head Claims Control Date of writing/updation of JD 20 th Apr 2026 Job Purpose: Write the purpose for which the job exists (in 2-3 lines) (Max 1325 Characters) The role is responsible for establishing and maintaining a robust claims control framework that ensures regulatory compliance, quality assurance, and risk mitigation across the claims process. It drives governance through audits, fraud prevention, and leakage control, while leveraging MIS, analytics, and dashboards to provide actionable insights. The position also focuses on continuous process improvement and automation, enabling efficiency, transparency, and adherence to industry standards in claims management. Dimensions: Mention quantitative or qualitative parameters that are relevant for the job and provide a better understanding of the scope and scale of the job. Business Workforce Number (Max 254 Characters) 7000 Unit Workforce Number (Max 254 Characters) 7000 Function Workforce Number (Max 254 Characters) 700 Department Workforce Number (Max 254 Characters) 260 Other Quantitative and Important Parameters for the job: Budgets/ Volumes/No. of Products/Geography/ Markets/ Customers or any other parameter Job Context & Major Challenges: Write the specific aspects of the job that provide a challenge (internal and external) to the jobholder in the context of the Business/Unit/Function/Department/Section ((Max 3975 Characters) About The Health Insurance Industry While the current market sees more than 15 non-life players in the private space and 5 exclusive private players in the health insurance space trying to capture a sizable market share, the nationalized service provider (6) remains a strong competitor. In addition to this the business dynamics are such that the overall market on an annual basis which is to the tune of roughly 10,000 Crs sees close to 85 % of the business renewing with the existing service provider itself. This narrows down the opportunity of the fresh business actually being seriously fought in the market to approximately 1500 odd Crs. With the SME and the start-ups being the driving force of Indian economy, the opportunity to cater to these segments is immense and is increasing manifold year on year. The challenge here therefore remains as to how we capture a larger share of the opportunity by developing specific solutions to cater each segment of the business. Also by creating an inexpensive and standardized solution to increase the reach into the pockets of channel partners across the country to harness on their captive business and explore new opportunities with them. Market Opportunities With the advent of medical advancements, lifestyle changes, change in Indian socio-economic scenario and Indian healthcare space, and the insurers are facing challenges to cater to the needs of this diverse clientele. Increasingly Indian customers have started considering health insurance partners as extensions of health advisers. In this scenario it becomes extremely important to understand their psyche and then provide tailored solutions with wellness benefits which would help them meet their end objectives and bring in profitable revenue source for the company. About The Aditya Birla Health Insurance Aditya Birla Health Insurance Co. Limited (ABHICL) was incorporated in 2015 as a 51:49 joint venture between Aditya Birla Capital Limited (ABCL) and MMI Strategic Investments (Pty) Ltd. ABHICL commenced its operations in October 2016. ABHICL has entered the competitive health insurance market with an aim to expand the category to wider customer segments, beyond the ones that health insurance companies traditionally have marketed to. As the 6th entrant in a category with well-established players, ABHICL is creating differentiation and equity for itself though the unique business proposition of Health Insurance for All, a one of a kind proposition in India at the moment. This is a philosophy that is being built through every single consumer touch point and into every single backend process of the company to ensure a customers experience of our proposition is continuous and seamless. ABHIs unique offering to market includes proposition includes - A Comprehensive Incentivized Wellness Program that will attract the young and health conscious and will motivate, guide and .