HR head or people lead · roughly 200 to 2,000
You were hired to build culture. You are reconciling an endorsement tracker.
Last reviewed:
Upstairs wants to know why the premium jumped. Downstairs assumes you bought a cheap policy. In between sits the work nobody counts: chasing a pre-authorisation at nine at night, explaining a discharge deduction to a family that is already frightened, and holding four vendors together who do not speak to each other.
This page is written for one chair. If it is not yours, start here instead.
20 minutes with a Growth Advisor. No obligation, and no quote pushed.
If this is your week
Somewhere between 500 and 2,000 people the job changes character. It stops being administration and becomes operations, and the thing that eats your week is no longer designing benefits. It is being the layer that holds the insurer, the TPA, the wellness vendor and the payroll file together, personally, every time one of them fails.
You should not be the integration layer for your own benefits.
What actually goes wrong
- Escalations are weekly now, not occasional. Each one is a real person in a real hospital, so none of them can be deprioritised, and together they consume hours your team was hired to spend elsewhere.
- The loss ratio is invisible until renewal. By the time you see the number, the window in which anything could have been negotiated has already closed.
- You are asked to justify the spend with a utilisation PDF. Leadership wants a defensible answer and the tools you inherited produce a document, not an argument.
- Experience varies by location, insurer and TPA. Two employees with similar cases get different outcomes, and the one who got the worse outcome tells everybody.
- Counter-offers are beating you on the things you cannot see. Parental cover and sum insured are where offers get compared now, and benchmarking anxiety is worst in exactly the band where no benchmark is available to you.
- Endorsements never stop. Joiners, leavers, dependants, corrections. It is a standing job dressed up as a monthly task, and a missed one is discovered at a hospital desk.
Over four in ten claimants in India face rejection or partial approval (LocalCircles, 2026). At your headcount that is not an abstract risk. It is a predictable number of families a year.
What we take off your desk
- The escalation itself. Every claim comes to Ethika’s own claims team, Red Carpet, before the insurer or the TPA sees it. We read the file line by line, catch the errors on your side of the table, and a named person stays with the employee until it is settled.
- The chasing. Enrolment, endorsements, e-cards, pre-authorisation follow-up and launch communication are run by us. HR time on the platform runs to about five minutes a month.
- The vendor seams. One place to see claims, cover and utilisation rather than four portals that each hold a piece of the answer.
- The renewal project. Started months ahead rather than weeks, with the year’s evidence assembled before the first conversation with an insurer, not after it.
The everyday half of the programme, Rise, is delivered by Ethika Worklife Private Limited, a separate company in the group. It runs alongside the insurance rather than inside it, which is also why it is priced and consented separately.
The answer you can send upstairs
The hardest part of this job is not the claim. It is being asked, once a year, to defend a number in a room where nobody else has read the policy. What makes that conversation survivable is evidence you did not have to assemble by hand.
What was used
Utilisation across the programme, not a vendor’s summary of its own performance.
What it cost
Claims experience as it builds through the year, so the renewal is not a surprise in month eleven.
What it prevented
The claims that were queried, corrected or recovered before anyone upstairs had to hear about them.
Reporting shows usage, never identities. Employee health data is held to run the benefit and the claim, under access controls, and is never sold or used to profile anyone.
What it looks like when it works
A knee replacement claim was approved, minus 75%. The insurer pointed to a reasonable and customary clause: the surgery looked costly next to nearby ones, so they cut the number. Our team went back to the placement file and found a modern treatments clause with no sub-limits, negotiated when the policy was put in place for exactly this kind of procedure. The deduction was reversed in full.
A real claim on a policy Ethika placed and serviced, shared with consent. Past experience. Outcomes depend on individual policy terms.
A policy is only as strong as the clauses someone fought to put in it, and then enforced. Both halves of that sentence are the job.
Proof, in public
Ask any broker for references and you get their three happiest clients. The more useful check is the review corpus nobody curates.
Much of the review writing is people thanking an Ethika person by name.
20 minutes with a Growth Advisor. No obligation.
Common questions
Will we still be dealing with the TPA?
Do we have to change insurer?
We are locked in with a broker our parent company appointed.
How long does a switch actually take, and will there be a gap?
What happens to an employee’s cover when they leave?
The week you get back is the point
Not a better portal. Fewer escalations, an evidenced renewal, and someone else on the phone at nine at night.
What happens when you talk to us
A 20-minute video call with a Growth Advisor. No obligation and no quote pushed. In that first call we usually look at:
- Where your escalations are coming from, and which of them are avoidable at placement
- What your wording does on room rent, sub-limits, maternity and mental health
- What evidence you can put in front of leadership at the next renewal
- Whether Ethika as your broker or alongside your broker fits your setup
You will leave with an honest read on your current cover and claims experience, and a straight answer on whether we can genuinely help.
20 minutes with a Growth Advisor. No obligation.
Not ready for a call? Stress-test your cover in ten minutes with no sign-up, or use the employee benefits survey template. Sitting in a different chair? See all six.
A note on this page. This page is general information about how cover and claims work for companies like yours. It is not insurance, legal, financial or tax advice, and nothing on it is an offer of cover. What is right for your company is determined through a conversation and the formal placement process. Outcomes on any claim depend on the individual policy terms.
Sources. Company figures are stated as published. Market figures are named with their source and year; no data published by a competing broker, benefits consultant or benefits platform is cited. Statutory positions are described in general terms.
Ethika Insurance Broking Pvt Ltd · IRDAI-licensed Direct Insurance Broker (Life & General), Certificate No. 574, licence dated 8 August 2016, valid till 7 August 2028 · CIN U66030TG2015PTC099365 · Principal Officer: Sandeep Mukka · Member, Insurance Brokers Association of India (IBAI). Insurance is the subject matter of solicitation.
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