# Assistant Manager - Claims Management

**Company**: Prudential Health India
**Location**: Mumbai
**Work arrangement**: onsite
**Experience**: senior
**Job type**: full-time
**Category**: Finance
**Industry**: Healthcare

**Apply**: https://prudential.wd3.myworkdayjobs.com/en-US/prudential/job/Mumbai/PHI---Assistant-Manager--Claims-Management_25080098?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_0c4a433c-844

## Description

Prudential Health India is seeking an Assistant Manager – Claims Management to join our Experience team in Mumbai.

As an Assistant Manager Claims, you will guide the TPA processing team by providing medical opinions for Health Insurance Claims, ensure claims are settled according to company practices and procedures, and process and approve medical claims.

Responsibilities:

- Guiding TPA processing team by providing medical opinion for Health Insurance Claims

- Ensuring claims of valid settlements are made according to company practice and procedures

- Processing and approving medical claims pertaining to Indemnity, Benefit for both Group and Retail

- Case management of potential cases to Network team

- Automation and rule-driven decision making

- Create and review claim simplification guidelines

- Medical decisioning and guidance to the team

- Audit of TPA processed claims and In-house processed claims

- Regulatory compliances

- Train TPA teams

- Benefit claims processing

- Collaborate with FWA Manager

- Re-UW opinion for non-disclosure cases

- Extend support to sales/distribution

- Set up and create robust governance to manage TPA process

Requirements:

- Doctor by training (MBBS/BAMS/BHMS/BDS)

- 3-5 years of experience in health insurance claim processing management

- 1-2 years of experience as a team leader

- Understanding of TPA ecosystem

- Experience in managing TPA model (Preferred)

- Startup experience or setting up a team from scratch (Preferred)

- Decisive and creative individual

- Quick decision-making and good judgment and analytical skills

- Excellent verbal and written communication skills

- Strong negotiation skills

What can make you extra special:

- Experience with digital tools to transform customer experience

- Knowledge of Blue Ocean strategy and Zero to One

## Skills

### Required
- Health Insurance Claims
- Medical Opinion
- Claims Management
- TPA Processing
- Regulatory Compliance

### Nice to have
- Digital Tools
- Blue Ocean Strategy
- Zero to One

---

Source: [Apply at prudential.wd3.myworkdayjobs.com](https://prudential.wd3.myworkdayjobs.com/en-US/prudential/job/Mumbai/PHI---Assistant-Manager--Claims-Management_25080098?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)