PHI - Assistant Manager- Claims MIS & Analytics

Prudential Health India; Mumbai; On-site; INR 600,000 - 800,000; Full time

Job summary

Prudential Health India is seeking an Assistant Manager for Claims Management in Mumbai. This role involves operational analytics, reporting, and improving process efficiency. The ideal candidate will have 4–8 years of experience in a related field, a degree in Statistics, Mathematics, or a similar discipline, and proficiency in Excel, SQL, and BI tools. Strong analytical and communication skills are crucial as the position requires collaboration with various stakeholders. Join a team committed to delivering exceptional health insurance services.

Qualifications

• 4–8 years of experience in MIS/Analytics roles, preferably in health or general insurance operations.
• Strong analytical and problem-solving skills.
• Excellent communication and stakeholder management.

Responsibilities

• Develop and maintain daily, weekly, and monthly MIS reports for claims operations.
• Conduct time-motion studies to identify inefficiencies in processes.
• Track and evaluate performance of TPAs and service providers.

Skills

Advanced Excel

SQL

Power BI

Tableau

Python

R

Education

Bachelor's or Master’s degree in Statistics, Mathematics, Computer Science, Actuarial Science, or a related field

Tools

Insurance core systems

Job description

Assistant Manager – Claims Management

We are looking for a talented Assistant Manager – Claims Management to join our Experience team in Mumbai.

Key Responsibilities

• 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.
• 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.
• 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 raise deviations to relevant stakeholders.
  • Support vendor audits and provide data-driven insights for contract renewals and negotiations.
• Regulatory & Compliance Reporting
  • Ensure timely and accurate submission of regulatory reports to IRDAI, IIB and other statutory bodies.
  • Reconcile 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.
• 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.
• 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.

Qualifications

• Bachelor’s or Master’s degree in Statistics, Mathematics, Computer Science, Actuarial Science, or a 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 or Tableau.
• Knowledge of Python or R for data analysis (preferred).
• Familiarity with insurance core systems (e.g., policy administration, 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.
• Understanding of the TPA ecosystem and experience managing TPA models (preferred).
• Experience in startup environments or building teams from scratch (preferred but not mandatory).
• Decisive, creative, and able to make quick decisions with good judgment.
• Excellent verbal and written communication, strong negotiation skills.
• Adaptable to change and able to manage it.

Preferred Certifications

• IRDAI Regulatory Compliance (if applicable).
• Six Sigma or Lean Certification (preferred).
• Data Analytics or BI certifications (e.g., Microsoft, Tableau).

Desired Attributes

• Passionate about consumer behaviour and culture; enjoy understanding customer needs.
• Valuing a culture of transparency and collaboration.
• Taking full responsibility for output and thinking cross-functionally to solve for the customer.
• Strong clinical knowledge and clinical decision-making skills.
• Track record of building best-in-class processes from scratch.
• Passionate about leveraging digital tools to transform customer experience.

Location: Mumbai

Equal Opportunity Employer
We are an equal‑opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation irrespective of sex, race, age, ethnic origin, educational, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability or part‑time / fixed‑term work, or any other status protected by applicable law. We encourage the same standards from our recruitment and third‑party suppliers taking into account the context of grade, job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements.