PHI - Assistant Manager- Claims MIS & Analytics

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 – Claim MIS or Analytics  

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

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)  
  • 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

Preferred Certifications:

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

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  
• 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.

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.

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