Assistant Manager - Operations

Prudential Health India is seeking an Assistant Manager - Operations to join their Experience team in Mumbai.

As an Assistant Manager - Claims, you will oversee the entire claims process from registration to settlement, ensuring adherence to SLAs and regulatory guidelines. You will implement and monitor controls to prevent fraud, abuse, and leakage, and ensure accurate adjudication and timely closure of claims.

Key Responsibilities:

• End-to-End Claims Management: Oversee the entire claims process from registration to settlement, ensuring adherence to SLAs and regulatory guidelines.
• Floor & Resource Management: Manage daily floor operations including team rostering, shift planning, and workload balancing.
• Process Optimization & Productivity: Identify process gaps and implement improvements to enhance efficiency and reduce turnaround time.
• Partner & Vendor Management: Liaise with TPAs, network hospitals, and other service providers to ensure smooth claims processing.
• Target Achievement & KPI Management: Define and monitor KPIs for team and individual performance.
• MIS & Reporting: Publish daily, weekly, and monthly MIS reports covering claims volumes, TAT, approval/rejection rates, and partner performance.
• Compliance & Regulatory Adherence: Ensure claims processing complies with IRDAI regulations and internal policies.

Requirements:

• Graduate/Postgraduate in Healthcare Management, Insurance, Business Administration, or related field.
• 7–12 years of experience in health insurance claims operations, with at least 3 years in a managerial role.
• Proficiency in Excel, SQL, and BI tools (Power BI/Tableau).
• Familiarity with claims management systems and TPA portals.
• Understanding of IRDAI regulations and health insurance products.
• Strong leadership and team management capabilities.
• Excellent communication and stakeholder management.
• Analytical mindset with a focus on continuous improvement.