# Business Solution Specialist - Claims

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

**Apply**: https://prudential.wd3.myworkdayjobs.com/en-US/prudential/job/Mumbai/Business-Solution-Specialist---Claims_24120128?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_cc7eda46-674

## Description

We are looking for a talented Business Solution Specialist - Claims to partner with us in our mission to make Indians healthier. As a Business Solution Specialist, your typical week might include collaborating with cross-functional workstreams for new products, processes, testing, and implementation.

Responsibilities:

- Collaborate and co-create with cross-functional workstreams for new products, processes, testing, and implementation.

- Ensure that processes and technologies are designed to focus on automation, scalability, and productivity.

- Develop in-depth understanding of business processes, articulate use-cases, user-stories, and requirement documents/change requests for identified features/capabilities for applicable platforms and projects.

- Collaborate with functions including Technology, Product & Actuarial, Claims, Compliance, Risk Management, and Finance.

- Review business process flow diagrams with Business Analyst to ensure comprehensive documentation.

- Identify pain points, bottlenecks, redundancies, delays, errors, or any other areas to enhance the process.

- Check if the current process complies with relevant regulations and industry standards.

- Review techniques such as flowcharts, BPMN diagrams, or process maps to illustrate the sequence of activities.

- Undertake iterations in signed-off Business Process Flow, when required, in collaboration with stakeholders to refine and finalize the next version.

- Perform process impact analysis across various platforms, holding an end-to-end view of user journeys.

- Ensure that acceptance criteria are defined and met.

- Lead testing in collaboration with functional users.

- Continuous enhancement of Overall Rules for Allocation, Auto Adjudication, Data masters, fraud trigger creation, and implementation for claims management process.

- Ensure 100% Tariff digitization for direct empanelment hospitals and preferred network.

- Coordination with relevant partners (TPA/Agencies) required for robust digitally led claims management process.

- Collaborate with relevant stakeholders, management Design, and execute staggered plan for 'Inhouse' Claims Process setup by Y3.

Requirements:

- At least 10 years of total experience in health insurance functions and 3-5 years' experience in Health Claims insurance.

- End-to-end knowledge of health insurance products, operations processes, and technology systems.

- Ability to understand high-level processes and convert them into detailed business requirement documents.

- Proven track record of end-to-end implementation and business outcome delivery of significant insurance systems.

- Strong analytical and problem-solving skills.

- Excellent verbal and written communication skills and strong negotiation skills.

- Ability to thrive in environments that celebrate co-creation and collaboration.

- High resilience – ability to manage yourself, your teams, and your peers when faced with ambiguity or failure.

## Skills

### Required
- health insurance
- claims management
- process improvement
- analytical skills
- communication skills

### Nice to have
- clinical knowledge
- digital tools
- problem-solving skills

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Source: [Apply at prudential.wd3.myworkdayjobs.com](https://prudential.wd3.myworkdayjobs.com/en-US/prudential/job/Mumbai/Business-Solution-Specialist---Claims_24120128?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)