Phi - Manager- Claims Management

Prudential

Mumbai, India
Medical opinion for health insurance claims
Process and approve medical claims
Fraud, waste, and abuse (fwa) approaches
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

Job Summary

  • 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.
  • As a Manager Claims, your typical week might include guiding processing team by providing medical opinion for Health Insurance Claims and ensuring claims of valid settlements are made according to the company practice and procedures.
  • 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.

Matching Summary

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.

Skills & Requirements

Must-have

  • Medical opinion for Health Insurance Claims
  • Process and approve medical claims
  • Fraud, Waste, and Abuse (FWA) approaches
  • Compliance and regulatory requirements
  • Standard operating process creation
  • Medical decisioning and guidance
  • Claims analytics and dashboard preparation

Nice-to-have

  • Passion for consumer behavior and culture
  • Embracing change and managing it
  • Challenging convention and taking risks
  • Leveraging digital tools for transformation
  • Reading Blue Ocean Strategy & Zero to One

Key Requirements

  • MBBS preferred /BAMS/BHMS/BDS
  • 07-10 years’ experience health insurance claims
  • 2-3 years’ experience in Manager role
  • Understands TPA ecosystem and managing TPA model
  • Startup experience or setting up a team from scratch
  • Managed team with Medical and Non-Medical background

Work Rights

Not specified

Tailored Resume

Cover Letter