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.
As a Assistant Manager Claims, your typical week might include the following:
Key Responsibilities:
- Oversee 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.
- Manage 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.
- Identify 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.
- Liaise with TPAs, network hospitals, and other service providers to ensure smooth claims processing.
- Monitor partner performance against SLAs and escalate deviations.
- Conduct periodic reviews and audits of third-party operations. 5. Target Achievement & KPI Management
- Define 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.
Publish 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.
- Ensure 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.
- 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
- 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
- Take help from others when stuck and encourage others when there are setbacks
- Take full responsibility for your own output while thinking wing to wing across the organization; to solve for the customer
- Have strong clinical knowledge and clinical decision-making skills • Have built best in class processes from a scratch.
- Are passionate about leveraging digital tools to transform customer experience What can make you extra special.
- It’s a great if you have already read books like Blue Ocean strategy & Zero to One. Before you saw them mentioned here.
- You have real stories to tell about how your team, and you challenged convention and took the path less travelled.
- We are keen to listen to your story; doesn’t matter if you tell these stories with a sigh or with excitement. We respect both versions. Truly.
Location : Mumbai
Prudential is 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.
