Assistant Manager – Claims MIS & Analytics

Prudential Health India is seeking an Assistant Manager – Claims MIS & Analytics to join their Experience team in Mumbai.

As a Assistant Manager Claims, your typical week might include developing and maintaining daily, weekly, and monthly MIS reports for claims, underwriting, policy servicing, and customer service operations.

Key Responsibilities:

1. Operational Analytics & Reporting

• Develop and maintain daily, weekly, and monthly MIS reports for claims, underwriting, policy servicing, and customer service operations.
• Create dashboards to track KPIs such as turnaround time (TAT), claim settlement ratios, productivity metrics, and exception handling.
• Analyze trends and variances to identify operational bottlenecks and recommend corrective actions.

2. Process Efficiency & Productivity Monitoring

• Conduct time-motion studies and workflow analysis to identify inefficiencies in operational processes.
• Collaborate with process owners to define and monitor productivity benchmarks across teams.
• Support automation initiatives by identifying manual tasks suitable for digitization or RPA.

3. Third-Party Performance Monitoring

• Track and evaluate performance of TPAs, network hospitals, and other service providers using SLAs and contractual KPIs.
• Generate periodic performance scorecards and escalate deviations to relevant stakeholders.
• Support vendor audits and provide data-driven insights for contract renewals and negotiations

4. Regulatory & Compliance Reporting

• Ensure timely and accurate submission of regulatory reports to IRDAI, IIB and other statutory bodies.
• Reconciliation of Monthly claim register with finance team
• Maintain audit trails and documentation for internal and external audits.
• Monitor compliance with data privacy, fraud detection, and grievance redressal norms.

5. Data Governance & Quality

• Ensure data integrity and consistency across systems and reports.
• Work with IT and data teams to resolve data discrepancies and improve data architecture.
• Define and implement data validation rules and reconciliation processes.

6. Stakeholder Collaboration

• Liaise with underwriting, claims, customer service, finance, and IT teams to gather requirements and deliver actionable insights.
• Present findings and recommendations to senior management through structured presentations and visualizations.

You could be the right candidate if you…

• Bachelor’s/Master’s degree in Statistics, Mathematics, Computer Science, Actuarial Science, or related field.
• 4–8 years of experience in MIS/Analytics roles, preferably in health or general insurance operations.

Technical Skills:

• Advanced Excel, SQL, Power BI/Tableau
• Knowledge of Python/R for data analysis (preferred)
• Familiarity with insurance core systems (e.g., policy admin, claims management)

Soft Skills:

• Strong analytical and problem-solving skills
• Excellent communication and stakeholder management
• Attention to detail and ability to work under tight deadlines
• Understands the TPA ecosystem and has experience of managing TPA model (Preferred)