Manager- Employee Benefits - Claims

Job Description

Role: Claims Management

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: Manager Employee Benefits Claims

Reporting to: Deputy Vice President

Job Summary/About the role:

A Medical Reviewer at Prudent Insurance Brokers would be responsible for reviewing medical information and data related to insurance claims, ensuring accuracy, completeness, and compliance with relevant regulations. They would analyze medical reports, documents, and data to determine the validity of claims and provide recommendations for claim processing. This role requires a strong understanding of medical terminology, clinical practices, and insurance regulations.

Required Qualifications:

BHMS/BAMS(with TPA/Insurance Company/Brokers background and good medical knowledge)

Required Experience and Skills:

• Medical Knowledge: Strong understanding of medical terminology, anatomy, physiology, and common medical conditions.
• Critical Thinking: Ability to analyze data, identify inconsistencies, and make sound judgments.
• Communication: Effective verbal and written communication skills to interact with clients and colleagues.
• Attention to Detail: Meticulous approach to ensure accuracy and completeness in all work.
• Regulatory Compliance: Knowledge of relevant insurance regulations and standards.
• Problem-Solving: Ability to identify and resolve discrepancies or issues within claims.

Key Responsibilities:

• Analyze medical records, reports, and data to assess the validity and accuracy of insurance claims.
• Ensure that all medical information and claim processing adheres to relevant regulations and standards.
• Determine the legitimacy of claims based on medical evidence and insurance policies.
• Work with internal teams (claims, operations, sales) and external stakeholders (clients, medical professionals).
• Generate reports and documentation related to reviewed claims.
• Stay updated on medical advancements and regulatory changes to improve processes.