REGINA S

End-to-End Claims Management – Customer Support and Individual Death Claims

Customer Support:

• Managing two team leaders, each overseeing a team of 30+ associates, with overall responsibility for driving customer satisfaction and operational excellence. Accountable for team performance, service quality, and delivering a seamless customer experience across all touchpoints.
• Handle grievances, escalate unresolved issues, and ensure end-to-end resolution.
• Educated and trained team members on end-to-end claim processes, including documentation requirements and processing timelines, to ensure accurate and efficient customer handling.
• Monitored and maintained Service Level Agreements (SLAs), ensuring timely resolution of customer queries and adherence to quality standards.
• Guided the team to consistently deliver a positive customer experience through empathy, clear communication, and proactive problem-solving.

Claims Handling & Assessment: Managed and guided a team through the end-to-end lifecycle of individual death claims, including the assessment of early and non-early claims. Referred eligible cases to reinsurers and ensured strict adherence to internal policies and regulatory guidelines. Monitored daily claim intimations and ensured timely processing within the defined Turnaround Time (TAT).

Case Management & Escalations: Conducted weekly reviews of complex and high-aging cases, taking necessary actions to expedite resolution.
Team Leadership and Performance: Led and motivated the claims team to achieve weekly and monthly targets. Published periodic performance reports and transactional quality scores for team members. Oversaw team performance metrics, and ensured continuous improvement through feedback and guidance.

Process Improvements & Innovation: Provided inputs for system enhancements and process improvements based on operational challenges and observations. Contributed to streamlining departmental workflows and reducing process gaps.

Quality Assurance and Compliance: Conducted quality checks on transactional activities, and maintained accurate data logs for audit and compliance. Ensured strict confidentiality of all claim-related information, and sensitive data.

Claims Settlement and Refund Processing: Prepared refund requests and processed future benefits as per policy terms and conditions. Managed payout processing for compliance orders and settlement deed cases.

Reporting & MIS: Tracked, analyzed, and published comprehensive MIS reports on claims performance, turnaround trends, and team productivity to support data-driven decision-making and continuous process improvement.

Fraud Prevention & Early Detection: Work proactively on new business data to detect red flags, including potential fraud, misrepresentations, and non-disclosures. Take preventive action to suppress such policies before a claim intimation is received.

Litigation Case Management Responsibilities:

• Managed and tracked litigation cases from initiation to resolution.
• Coordinated effectively with legal counsel and advocacy teams to ensure timely, accurate case handling.
• Analyzed reasons for claim repudiation in litigation matters, and compiled relevant evidence to support defense strategies.
• Processed payouts in accordance with compliance orders and settlement deeds, ensuring regulatory adherence.
• Provided necessary documentation and evidence to legal teams for effective defense in litigation proceedings.

Key Responsibilities – Claims Management

• Claim Intimation Handling: Assess the validity of claim intimations with accuracy and process them accordingly. Upon receipt of all required documents, evaluate and process claims within the defined turnaround time (TAT). Seek expert opinions—legal, medical underwriting, or reinsurer—wherever required, to make an informed decision regarding claim acceptance or rejection.
• Requirement Follow-ups: Conduct timely follow-ups for pending documentation with customers through reminder letters, phone calls, branch operations teams, and the sales force, in accordance with the Claims Process Guidelines.
  Engage with external investigation agencies and obtain summarized reports where applicable, to support claim decisions.
• Inter-Company Liaison: Coordinate with other life insurance companies to mutually share case-specific information, with the necessary approvals and in consultation with the Claims Manager.
• Grievance Resolution: Manage generic claims mailboxes and respond effectively to queries and grievances raised by customers, branches, and internal departments.

Joined as Team Leader handling quality assurance and operations

Key Responsibilities & Accomplishments:

• Pilot Batch Management: Successfully led and managed the pilot batch, establishing key quality benchmarks and operational workflows.
• Training & Onboarding: Acted as a Trainer for new joiners and team members, ensuring effective knowledge transfer and alignment with organizational standards.
• Customer Handling: Personally handled Platinum Customers, ensuring top-tier service delivery, client satisfaction, and quick resolution of escalations.
• Quality Oversight: Maintained high standards of service quality, conducted audits, and provided regular feedback to improve team performance and compliance.

Company Overview: Key Processes and Responsibilities: 1. Product Development (PD); 2. First-Time Production; 3. Global Coordination.

• Responsible for determining the price of each product.
• Pricing is based on: The type of material used, and the production facility type (e.g., Offset, PFL, Thermal, Flexo, Woven).
• Updates product prices in the local system prior to production.
• When a product enters its first production cycle, a specification sheet is created that includes material details and any special processes involved in production.
• Works with overseas Key Account Managers (KAMs) for: New product inquiries, participation in global tenders related to major international programs such as: Tommy Hilfiger, Tesco, Sainsbury, George

Senior Customer Support & Operations Team Lead Responsibilities:

• Handled high-volume inbound calls related to customer queries and complaints covering general insurance aspects: prospect inquiries, renewals, endorsements, claims, and cancellations.
• Responded to customer concerns received via multiple channels including email and WhatsApp.
• Assisted walk-in customers and provided end-to-end support on grievance escalations and resolution.
• Generated a minimum of 4 cross-sell leads per day, contributing to revenue growth and customer engagement.
• Conducted RCA (Root Cause Analysis) regularly to identify volume drivers and service gaps for process improvement.

Leadership & Operations Management:

• Acted as manager in their absence — taking part in decision-making, attending strategy meetings, and preparing detailed center performance reports.
• Hired and trained new staff in collaboration with HR and trainers, ensuring they were aligned with company policies and quality expectations.
• Led a team of 15+ Customer Experience Associates, helping them achieve individual KPIs and the team’s overall customer satisfaction goals.
• Monitored team performance using KPIs (SL, AHT, NPS) and implemented corrective actions when targets were not met.

Process Improvement & Strategic Initiatives:

• Developed automation and digital tools that simplified customer service processes and improved efficiency.
• Worked cross-functionally with the marketing team to launch portals and support material in major Indian languages (e.g., website, help sections, awareness leaflets, comic books).
• Played a key role in the development and implementation of a customer service chatbot to improve responsiveness and reduce repetitive queries.
• Supported all UAT (User Acceptance Testing) phases for new modules and provided key feedback from a customer service perspective.
• Coordinated with internal departments (Finance, Sales, Renewal, Claims, Endorsements) to ensure smooth and efficient operations.

Training & Quality Management:

• Implemented and led training programs for new and existing associates, which led to a measurable reduction in customer complaints and improved feedback scores.
• Conducted regular crash courses aimed at improving Net Promoter Score (NPS) and service quality.
• Delivered weekly/monthly performance reports with actionable insights and strategic recommendations for continuous improvement.

Customer Support Executive

Checkpoint ALS (Manufacturing Company – Labels, Tags, and Stickers for Garments).

Key Responsibilities:

• Acted as the primary point of contact for global customers, handling order-related communication via email and phone.
• Processed customer orders based on product-specific programs, coordinating with internal departments to ensure a smooth workflow.
• Collaborated with the MAC (artwork development) team to create product designs (labels, tags, stickers) in accordance with customer requirements.
• Managed the approval cycle by sending artwork to customers, and moving approved designs into production.
• Liaised with the production team to finalize delivery timelines, and ensured timely communication of dispatch dates to customers.
• Ensured high levels of customer satisfaction by providing proactive support and timely updates throughout the order fulfillment process.

Office Administration & Support Responsibilities

• Office Management: Effectively oversee daily office operations, ensuring a well-organized and efficient workspace. Manage office supplies and equipment, addressing facility needs to maintain a productive environment.
• Communication & Coordination: Serve as the primary point of contact for internal teams and external stakeholders. Handle correspondence including emails and phone calls, while organizing and coordinating meetings, events, and appointments.
• Record Keeping & Data Management: Maintain accurate records, databases, and filing systems. Ensure timely updates and compliance with internal standards and regulatory requirements.
• Staff & Management Support: Provide administrative assistance to staff and leadership by facilitating interdepartmental communication, managing resource needs, and supporting various office functions.
• Compliance & Policy Adherence: Monitor and support adherence to company policies and procedures. Help implement compliance initiatives and maintain documentation for audits and training purposes.
• Financial Administration: Assist in financial processes such as expense reimbursements, invoice tracking, and basic bookkeeping tasks, ensuring timely and accurate processing.
• Project Support: Support project teams by tracking deadlines, coordinating activities, and ensuring smooth execution of assigned tasks.