Assistant Manager-Employee Benefits-Claims

Job Description

Role: Claims

Department: Employee Benefits Practice

About Us:

Prudent is a Composite Insurance Broker regulated by the Insurance Regulatory and Development Authority of India (IRDAI) and headquartered in Mumbai, India. Prudent is one of the leading insurance brokers in the country. We specialize in building long-term relationships and instilling confidence in our partners. As a partner-focused organization, we are committed to delivering best-in-class insurance solutions and services tailored to meet the diverse needs of our clients.

Recognized as:

• Great Place to Work 2024 and 2025 - This achievement reflects our unwavering commitment to a workplace where innovation, collaboration, and success go hand in hand; thanks to each Prudent family member for being the driving force behind our success.
• One of ! This honor reflects our unwavering commitment to fostering a culture where every woman can thrive and shine, and every voice is heard. Together, were building a future of , , and for all team members!!

Job Title: Assistant Manager Employee Benefits Claims

Reporting to: Deputy Vice President

Job Summary/About the role:

The position will involve claims analysis and processing facilitation in coordination with different TPAs and Insurance companies.

Required Qualifications:

A minimum of a bachelors degree in any stream.

Required Experience and Skills:

• Should have 5-7 years of experience in Health claims processing (Cashless/Reimbursements)
• Good knowledge about the TPA/Insurance processes
• Well verse with health insurance policy conditions
• Well verse with current medical practices & advancements
• Should have knowledge about IRDA health regulations
• Good communication skills
• Problem solving attitude
• Decision making
• Should be well verse with MS office.

Key Responsibilities:

• Managing relations with TPAs/Insurers to ensure claims SLA is maintained.
• Interacting with client HRs to resolve their claims related queries, if required.
• Explaining clients on the policy terms related queries over the call or mail.
• Reviewing denial claims sent by TPAs & ensuring that denial is done as per policy terms.
• Representing client claims to insurer/TPA in case of ambiguity in settlement/denial
• Supporting Analytics team in data analytics.
• Visiting insurer office whenever required to get the necessary approvals on claims.
• Supporting client servicing teams in claims related issues whenever required.