PHI - Assistant Manager- Operations

prudential; Mumbai; On-site; INR 1,800,000 - 2,400,000; Full time

Job summary

Prudential Health India is seeking an Assistant Manager - Claims Management to join the Experience team in Mumbai. You will oversee end-to-end claims, manage floor operations, drive process improvements, and coordinate with TPAs and hospitals to ensure timely, compliant settlements.

The role requires 7–12 years in health insurance claims with at least 3 years in management, strong Excel/SQL/BI skills, and familiarity with TPA portals. IRDAI knowledge and Lean Six Sigma are preferred.

Qualifications

• 7–12 years of experience in health insurance claims operations.
• At least 3 years in a managerial role.
• Proficiency in Excel, SQL, and BI tools.
• Familiarity with claims management systems and TPA portals.
• Understanding of IRDAI regulations and health insurance products.
• Lean Six Sigma Green Belt or higher is preferred.
• Data analytics or MIS reporting certification is a plus.

Responsibilities

• End-to-End Claims Management: oversee registration to settlement, ensure SLAs and regulatory adherence, curb fraud and leakage.
• Floor & Resource Management: rostering, shift planning, workload balancing, real-time productivity monitoring.
• Process Optimization & Productivity: identify gaps, digitize workflows, explore RPA opportunities, improve KPIs.
• Partner & Vendor Management: liaise with TPAs and hospitals, monitor SLA performance, conduct audits.
• Target Achievement & KPI Management: set targets, track progress, drive continuous improvement.
• MIS & Reporting: publish daily/weekly/monthly MIS, ensure data accuracy, present insights to senior management.
• Compliance & Regulatory Adherence: ensure IRDAI compliance, assist audits, maintain grievance records.

Skills

Excel

SQL

BI tools

Leadership

Stakeholder management

Education

Graduate/Postgraduate in Healthcare Management or Insurance or Business Administration

Tools

Power BI

Tableau

TPA portals

Claims management systems

Job description

Prudential's purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured, for our people, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and we support our people's career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.

Prudential (UK) in partnership with HCL group plans to set-up a standalone Indian health insurance company to address the growing healthcare needs of the Indian consumer.

This joint venture will combine Prudential's global expertise in insurance and financial services with HCL Group's experience in technology and healthcare solutions.

Prudential, with its longstanding presence in India, already operates two leading businesses in life insurance and asset management with the ICICI Group. Prudential was also the proud sponsor of the 1983 Cricket World Cup, India's first World Cup Victory!

Prudential Health India is a Zero to One team undertaking a no-legacy, greenfield health insurance deployment in India, building journeys that truly empathize with the customer and offer a differentiated experience.

To partner with us in this mission, we are looking for a talented Assistant Manager - Claims Management to join our Experience team in Mumbai.

Assistant Manager - Operations and floor management

As a Assistant Manager Claims, your typical week might include the following:

Key Responsibilities

1. End-to-End Claims ManagementOversee the entire claims process from registration to settlement, ensuring adherence to SLAs and regulatory guidelines.Implement and monitor controls to prevent fraud, abuse, and leakage.Ensure accurate adjudication and timely closure of claims.
2. Floor & Resource ManagementManage daily floor operations including team rostering, shift planning, and workload balancing.Monitor real-time productivity and allocate resources dynamically to meet demand.Drive employee engagement and performance through coaching and feedback.
3. Process Optimization & ProductivityIdentify process gaps and implement improvements to enhance efficiency and reduce turnaround time.Collaborate with IT and automation teams to digitize manual workflows and introduce RPA where applicable.Track and improve key operational metrics such as claims per FTE, TAT, and error rates.
4. Partner & Vendor ManagementLiaise with TPAs, network hospitals, and other service providers to ensure smooth claims processing.Monitor partner performance against SLAs and elevate deviations.Conduct periodic reviews and audits of third‑party operations.
5. Target Achievement & KPI ManagementDefine and monitor KPIs for team and individual performance.Set monthly/quarterly targets aligned with business goals and track progress.Drive accountability and continuous improvement through data‑backed insights.
6. MIS & ReportingPublish daily, weekly, and monthly MIS reports covering claims volumes, TAT, approval/rejection rates, and partner performance.Present dashboards and insights to senior management for strategic decision‑making.Ensure data accuracy and integrity across all reports.
7. Compliance & Regulatory AdherenceEnsure claims processing complies with IRDAI regulations and internal policies.Support internal and external audits with required documentation and data.Maintain grievance redressal records and ensure timely resolution.

You could be the right candidate if you...

• 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
• Understands the TPA ecosystem and has experience of managing TPA model (Preferred) - Have startup experience or setting up a team from scratch (Preferred but not mandatory)
• Should be a decisive & creative individual.
• Should be able to make quick decisions and have good judgment and analytical skills - Have an excellent verbal and written communication skills and strong negotiation skills.
• Always open to embracing change and be able to manage it
• Lean Six Sigma (Green Belt or higher)
• Health Insurance or Claims Adjudication Certification
• Data Analytics or MIS Reporting Certification

This could be the gig for you if you...

• Are passionate about consumer behaviour and culture; enjoy spending time with customers to understand what they really want. Have an attentive ear listen to new ideas.
• Like to work in a culture where everyone can see what others are doing