Assistant Manager - EB Claims

About This Job

Prudent Insurance Brokers Pvt Ltd.

Location: Mumbai, Maharashtra, India

Work Mode: On-site

Industry: Insurance

Job Description

Job Description

Role - Individual Contributor

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.

Recognised As

Great Place to Work – 2024,2025 and 2026 - 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 honour reflects our unwavering commitment to fostering a culture where every woman can thrive and shine, and every voice is heard. Together, we’re building a future of , , and for all team members!!’ ™ This recognition underscores our commitment to fostering a people-first culture, driven by excellence, trust, and collective growth.

Job Title - Assistant Manager - EB Claims

Reporting to - Manager - EB Claims

Branch - Mumbai

Job Summary/About the Role - To manage all activities related to employee/patient insurance, ensuring comprehensive coverage, compliance, and effective claims processing.

Required Qualifications - Bachelor’s Degree

Required Experience and Skills:

Proven experience in operations management or a related leadership role, preferably within the insurance or healthcare industry.Strong knowledge of GMC policies, insurance regulations, and compliance standards is highly desirable.Exceptional leadership, communication, and interpersonal skills.Strong analytical and problem-solving abilities, capable of making data-driven decisions.Ability to manage multiple priorities and work effectively in a fast-paced environment.Managing relations with TPAs/Insurers to ensure claims SLA is maintained.Representing client claims to insurer/TPA in case of ambiguity in settlement/denial.

Key Responsibilities

Policy Administration and Compliance:

Develop, implement, and review operational policies and procedures for GMC policy management.Ensure all processes remain legally compliant with insurance regulations and company policies.Manage policy renewals, endorsements, and updates in a timely manner.

Claims Management Oversight

Oversee the end-to-end claims process, ensuring efficiency, accuracy, and timely resolution for all employees.Liaise with insurance providers and Third-Party Administrators (TPAs) to resolve complex claims issues and disputes effectively.

Stakeholder Management

Serve as the primary point of contact for insurance brokers, providers, and TPAs.Collaborate closely with internal departments (HR, Finance, Legal) to align GMC operations with overall business objectives.Address employee inquiries and issues regarding policy coverage and claims, ensuring high-quality customer service.

Process Improvement And Strategy

Analyse operational data and performance metrics to identify inefficiencies and implement improvement strategies.Formulate strategic and operational objectives to enhance the quality and cost-effectiveness of the GMC program.Manage budgets, track expenses, and use financial data to improve profitability and resource allocation.

Team Leadership And Development

Lead, mentor, and supervise the operations team, setting clear performance goals and fostering a collaborative environment.Assist HR with recruiting and training new staff members when necessary.