Atul Kalia
Pune
Summary
Detail-oriented claims governance manager with a focus on operational excellence and compliance. Known for developing control mechanisms that minimize risks and enhance service quality while driving effective customer experience initiatives.
Overview
3
3
Certifications
16
16
years of professional experience
3
3
Languages
Work History
Senior Associate Manager
Bajaj General Insurance Limited
05.2025 - Current
- Spearheaded end-to-end operations for health insurance claims, ensuring regulatory compliance and organizational standards.
- Developed control mechanisms to identify operational leakage, policy deviations, compliance gaps, and emerging business risks.
- Implemented claim adjudication strategies that improved efficiency, quality, turnaround time, and customer satisfaction. Led governance audits, risk assessments, and compliance reviews to reinforce controls and minimize process gaps.
- Collaborated with underwriting, medical provider network, fraud control, customer service, finance, and technology teams to resolve complex claims issues.
- Managed escalated high-value claims, ensuring timely resolution while balancing customer experience with financial prudence.
- Ensured adherence to IRDAI guidelines, policy terms, internal SOPs, and audit requirements. Analyzed claim trends and operational data to identify improvements and mitigate risks supporting strategic decisions.
- Led cross-functional teams to streamline claims processing and enhance customer service efficiency.
- Developed training programs for new associates, improving onboarding experience and team productivity.
Manager
Bajaj General Insurance Limited
02.2023 - 05.2025
- Led health and personal accident insurance operations, ensuring compliance with governance standards and regulations.
- Managed performance frameworks, including business KPIs and operational reporting for productivity governance.
- Strengthened internal controls and risk governance to enhance service quality and process efficiency.
- Collaborated with audit analytics and stakeholders to improve governance effectiveness and operational stability. Drove initiatives for customer experience improvement through optimized escalation management processes.
- Supported strategic planning with data-driven reporting, operational reviews, and governance tracking.
- Developed team capabilities to achieve operational excellence and ensure compliance awareness.
- Improved claims reconciliation controls and turnaround efficiency through structured monitoring mechanisms.
- Led cross-functional teams to enhance operational efficiency and streamline processes.
- Developed and implemented strategic initiatives to improve customer service satisfaction levels.
- Mentored junior staff, fostering professional development and team collaboration.
Deputy Manager
Bajaj General Insurance Limited
03.2021 - 05.2023
- Coordinated governance and compliance activities for internal and external ISO audits across operations.
- Managed operational controls for claims governance, reconciliation, and monitoring of turnaround performance to ensure compliance.
- Supported implementation of governance frameworks, SOP standardization, and compliance monitoring mechanisms.
- Contributed to risk identification, control enhancements, and operational improvements per regulatory requirements.
- Collaborated with cross-functional teams to enhance customer service governance and streamline operational processes.
- Supported automation initiatives for claims administration, contributing to improved operational effectiveness.
Provider Network & Customer Operations Management
Bajaj General Insurance Limited
11.2010 - 03.2021
- Coordinated relationships with healthcare providers, managed empanelment processes, and governed compliance tasks to enhance network effectiveness.
- Spearheaded provider engagement strategies focused on operational support and service quality improvements.
- Conducted negotiations and commercial discussions to optimize healthcare network operations and align provider objectives.
- Managed wellness operations, driving member engagement and supporting customer service initiatives and implemented health check-up campaigns and wellness programs, increasing member participation and engagement in wellness initiatives.
- Supported enhancement of customer experience through streamlined operational processes and stakeholder collaboration.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments and skilled at working independently and collaboratively in a team environment.
Education
MBA - Finance
Indian Institute And Education And Business Management
Pune, India 04.2001 -
Skills
Claims Operations Management Claims Governance IRDAI Compliance Risk Management Claims Analytics Fraud Prevention Operational Excellence and process improvement Digital Transformation Stakeholder Management People Leadership and capability development I KYC reviews I Escalation & Crisis Management
Claims Adjudication
Certification
Certified Scrum Master
Timeline
Senior Associate Manager
Bajaj General Insurance Limited
05.2025 - Current
Manager
Bajaj General Insurance Limited
02.2023 - 05.2025
Deputy Manager
Bajaj General Insurance Limited
03.2021 - 05.2023
Provider Network & Customer Operations Management
Bajaj General Insurance Limited
11.2010 - 03.2021
MBA - Finance
Indian Institute And Education And Business Management
04.2001 -
Accomplishments
- Improved claims turnaround time (TAT) by 25% through structured monitoring and workflow optimization
- Reduced claims reconciliation discrepancies by 15%, minimizing financial leakage and improving accuracy
- Strengthened control environment, leading to successful IRDAI audit outcomes with minimal/zero major observations
- Enhanced claims governance and compliance adherence, reducing operational and regulatory risk exposure
- Implemented KPI-driven performance frameworks, improving claims productivity and service delivery efficiency by 20%
- Drove cross-functional alignment across claims, compliance, and analytics teams, improving process consistency and issue resolution timelines
- Led transformation initiatives that improved customer experience and claim processing reliability
- Managed high-volume claims environments 4.4 Lakh +(0.44 M) claims annually) ensuring accuracy, compliance, and service excellence
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Affiliations
- Certified Scrum Master
- Certified "Operational Risk, Cyber Security and Data Privacy India Program"
- Certified "Lead Auditor ISO 9001 – 2015 – DNV"
Languages
English
Advanced (C1)
Punjabi
Advanced (C1)
Hindi
Advanced (C1)
Work Preference
Location Preference
HybridImportant To Me
Work-life balanceCompany CulturePersonal development programsTeam Building / Company RetreatsStock Options / Equity / Profit SharingInterests
Cricket
Spiritualism
Quote
Opportunities Don't happen.You create them.
Chris Grosser