Walk-in || Claim Processing Executive

Job Description Claims Processing Executive

Position : Claims Processing Executive

Department: Claims / Operations

Role Objective

The Claims Processing Executive will be responsible for end-to-end processing and validation of customer claims, ensuring accurate claim assessment, timely settlement, SLA and TAT adherence, proper documentation, query resolution, and MIS reporting.

The candidate should have a good understanding of FMCG business processes and commercial transactions, along with strong analytical and Excel skills.

Key Responsibilities

1. Claims Receipt & Client Coordination

• Coordinate with clients/customers for timely receipt of claims and supporting documents.
• Ensure all claims are received as per the agreed process and timelines.
• Maintain proper Inward/Outward Claims Tracker and monitor claim movement.
• Follow up with clients for missing or incomplete documents/information.
• Ensure all claims are properly recorded and tracked from receipt to closure.

2. Claims Validation & Processing

Validate various types of FMCG claims, including:

• Incentive Claims
• TOT (Turnover/Trade Offer) Claims
• Display Claims
• Visibility Claims
• Promotional and scheme-related claims
• Other customer/trade claims as applicable

Key validation activities will include:

• Verification of claim calculations and supporting workings.
• Validation of quantities, rates, schemes, periods, and applicable commercial terms.
• Cross-checking claims against approved agreements, schemes, invoices, sales data, and supporting documents.
• Identification of duplicate, excess, incorrect, or unsupported claims.
• Ensuring claims are processed strictly as per agreed SOPs and client requirements.

3. Calculation & Commercial Validation

• Validate the mathematical accuracy of claim workings.
• Check applicable rates, percentages, slabs, quantities, and eligibility criteria.
• Verify claim calculations against agreed commercial terms.
• Identify financial discrepancies and highlight exceptions to the concerned stakeholders.
• Apply sound business sense and commercial understanding while evaluating claims.

4. Statutory & Compliance Validation

• Ensure claims comply with applicable statutory, tax, and documentation requirements.
• Verify required supporting documents and statutory information.
• Ensure adherence to client-specific compliance requirements and internal SOPs.
• Maintain proper audit trail and documentation for processed claims.

5. Query Resolution

• Identify and raise queries for incomplete, incorrect, or unsupported claims.
• Coordinate with clients, sales teams, finance teams, and internal stakeholders for query resolution.
• Maintain a proper Query Tracker and ensure timely closure.
• Follow up proactively to avoid delays in claim settlement.

6. Timely Settlement & SLA Adherence

• Ensure claims are processed and settled within the agreed SLA and TAT.
• Monitor ageing of pending claims and escalate potential SLA breaches.
• Prioritize claims based on agreed business timelines.
• Ensure there is no avoidable backlog due to internal processing delays.

7. MIS & Dashboard Management

• Prepare daily/weekly/monthly claims MIS.

• Maintain dashboards covering:

• Claims received

• Claims processed

• Claims settled

• Claims pending

• Claims under query

• Ageing

• TAT performance

• SLA adherence

• Value of claims processed/settled

• Provide accurate and timely reports to management and clients.

8. Process & Compliance Adherence

• Strictly follow defined SOPs, SLAs, TATs, and quality standards.
• Maintain complete documentation and audit trails.
• Ensure process compliance and highlight any deviations immediately.
• Support internal and client audits whenever required.
• Continuously identify opportunities for improving claims processing accuracy and turnaround time.

Key Performance Indicators (KPIs)

• Claims processing accuracy
• SLA adherence
• TAT adherence
• Timely claim settlement
• Number/value of claims processed
• Query resolution TAT
• Pending claims ageing
• Reduction in processing errors
• MIS accuracy and timeliness
• Compliance adherence
• Customer/client satisfaction

Candidate Profile

Qualification:

• B.Com graduate preferred.

Experience:

• 1–2 years of experience in claims processing, commercial operations, finance operations, reconciliation, accounts, or FMCG back-office operations.
• Experience in FMCG claims processing will be an added advantage.

Required Skills

• Strong proficiency in MS Excel including:

• VLOOKUP/XLOOKUP

• Pivot Tables

• SUMIFS/COUNTIFS

• IF formulas

• Data filtering and reconciliation

• Basic data analysis

• Good numerical and analytical skills.

• Strong attention to detail.

• Good written and verbal communication skills.

• Ability to coordinate effectively with clients and internal teams.

• Good understanding of FMCG commercial/business processes.

• Strong follow-up and query-resolution skills.

• Ability to manage multiple activities and meet strict deadlines.

Ideal Candidate

The ideal candidate should be commercially aware, analytical, detail-oriented, and highly disciplined about TAT and SLA commitments.

The person should not only check whether the claim calculation is mathematically correct, but should also understand the business logic behind the claim, commercial terms, customer expectations, and FMCG trade practices.

Core responsibility:
Receive Validate Calculate Query Resolve Process Settle Report Ensure Compliance.

Reporting

Reporting To: Manager / Team Leader – Claims Operations

Location

Mumbai / Navi Mumbai