AVP / VP – Operations | Health Insurance
Location: Mumbai
Function: Health Insurance Operations
Reporting To: Founders / CEO
Experience: 7-15+ years
Preferred Background: Doctor / medical professional with health insurance experience strongly preferred
About FlashAid
FlashAid is building a technology-led insurance distribution and servicing platform focused on simplifying health and general insurance for corporates, SMEs, affinity partners and their members.
As we scale rapidly, we are looking for a senior operations leader who can build a highly efficient, customer-centric and technology-driven health insurance operations function covering policy issuance, endorsements, claims, medical coordination, insurer/TPA management and grievance resolution.
Role Overview
The AVP / VP – Operations, Health Insurance will own the end-to-end operational delivery of FlashAid’s health insurance business.
The role requires a strong understanding of Group Mediclaim, retail health insurance, claims, medical terminology, policy conditions, underwriting and insurer/TPA processes.
A doctor/MBBS professional who has subsequently built experience within health insurance, claims, TPA, underwriting or insurance operations would be strongly preferred, given the significant medical interpretation involved in claims and customer servicing.
This is a hands-on leadership position responsible for building processes capable of handling significant scale while maintaining strong customer experience and operational SLAs.
Key Responsibilities
1. End-to-End Health Insurance Operations
Own the complete operational lifecycle from customer onboarding to policy issuance and servicing, including:
* Policy issuance
* Member additions and deletions
* Endorsements
* CD balance management and reconciliation
* Policy documentation
* Employee/member data validation
* E-cards and policy communication
* Renewals
* Insurer and TPA coordination
* Operational MIS and reporting
Ensure high accuracy and defined turnaround times across all operational processes.
2. Claims Management
Build and manage an effective cashless and reimbursement claims support function.
Responsibilities include:
* Cashless pre-authorisation coordination
* Reimbursement claim management
* Claim document review
* Claim deficiency resolution
* Claim escalation
* Rejected / repudiated claim analysis
* Medical and policy-condition interpretation
* Coordination with hospitals, TPAs and insurers
* Complex claim resolution
The leader should be capable of independently reviewing difficult medical claims and identifying whether the issue relates to:
* Policy exclusions
* Medical necessity
* Pre-existing conditions
* Waiting periods
* Non-disclosure
* Medical documentation
* Treatment protocols
* Policy terms and conditions
3. Medical Claims & Clinical Review
For candidates with a medical background, the role will also involve providing clinical oversight for complex claims.
Review medical records including:
* Discharge summaries
* Diagnostic reports
* Doctor prescriptions
* Investigation reports
* Treatment protocols
* Medical history
* Hospitalisation documentation
Work with insurer medical teams to resolve medically complex or disputed claims.
Develop internal medical guidelines to assist the claims and customer-support teams.
4. Insurer & TPA Management
Develop strong working relationships with:
* General and health insurers
* TPAs
* Claims teams
* Underwriting teams
* Medical teams
* Network hospitals
Drive improvements in:
* Policy issuance TAT
* Cashless approvals
* Claim settlement timelines
* Escalation resolution
* Endorsement processing
* Customer servicing
Conduct regular operational reviews with insurer and TPA partners.
5. Customer Experience & Escalations
Own customer experience across the insurance servicing lifecycle.
Personally intervene in critical or sensitive cases involving:
* Hospitalisation
* Cashless rejection
* Claim repudiation
* Emergency medical situations
* Corporate HR escalations
* Senior management escalations
Establish a structured escalation mechanism with clear accountability and turnaround times.
6. Process & Technology Automation
Work closely with the technology and product teams to digitise and automate insurance operations.
Identify opportunities to automate:
* Policy issuance
* Member onboarding
* Endorsements
* Claims tracking
* Customer communication
* Document collection
* Insurer reconciliation
* Claims escalation
* MIS reporting
The objective is to build an operating model capable of supporting large volumes without proportionately increasing manpower.
7. Operational SLA Management
Define and monitor service-level metrics across the organisation.
Indicative metrics would include:
* Policy issuance within defined TAT
* Endorsement completion TAT
* Claim registration TAT
* Cashless coordination TAT
* Reimbursement claim settlement TAT
* Customer grievance closure TAT
* Data accuracy
* Operational error rate
* Customer satisfaction
* Claims escalation rate
8. Claims Analytics & Loss Ratio
Work closely with insurers and corporate clients to analyse:
* Claim frequency
* Claim severity
* Disease patterns
* Hospitalisation trends
* High-value claims
* Utilisation trends
* Loss ratios
Develop actionable insights that can improve:
* Renewal pricing
* Employee wellness programmes
* Product design
* Claims management
* Insurer negotiations
9. Team Leadership
Build and lead teams across:
* Policy operations
* Claims
* Endorsements
* Customer servicing
* Escalations
* Medical claims review
Create clear KRAs, productivity benchmarks and quality-control mechanisms for the team.
Coach junior team members on insurance products, claims interpretation and customer handling.
Candidate Profile
Preferred Qualification
Strong preference for:
* MBBS / BDS / BHMS / BAMS or other recognised medical qualification with relevant insurance experience
OR
* Experienced health insurance professional with deep expertise in claims and operations.
Additional qualifications such as MBA, Insurance, Hospital Administration or Healthcare Management would be advantageous.
Experience
Ideally 10–15+ years of experience, with substantial experience in one or more of:
* Health insurance company
* General insurance company
* Health TPA
* Insurance broker
* Employee benefits platform
* Hospital insurance desk
* Medical claims / underwriting
* Corporate health insurance operations
Candidates currently working as VP / AVP / Head of Claims / Head of Health Operations / Medical Head / Claims Head / Operations Head would be particularly relevant.
Key Skills
The ideal candidate should have:
* Deep understanding of Group Mediclaim / GMC
* Strong knowledge of health insurance policy wordings
* Strong medical claims interpretation capability
* Understanding of cashless and reimbursement claims
* Knowledge of IRDAI health insurance regulations
* Strong insurer and TPA relationships
* Excellent escalation-management capability
* Strong process orientation
* Data and MIS orientation
* Ability to build and manage large teams
* High customer empathy
* Strong problem-solving capability
* Ability to operate in a fast-growing organisation
What Success Looks Like
The successful candidate will build an operations organisation where:
* 98%+ policies are issued within committed timelines
* Claims receive proactive intervention rather than reactive follow-up
* Corporate clients have clear visibility into servicing and claims
* Critical customer escalations are resolved rapidly
* Operational errors remain extremely low
* Technology replaces repetitive manual operations
* Claims and servicing capacity scales significantly faster than manpower
* FlashAid becomes known for exceptional post-sale health insurance servicing
Why Join FlashAid
This is an opportunity to build the health insurance operations architecture of a rapidly scaling insurance platform from the ground up.
The role will have direct visibility with the founders and significant ownership over operations, claims, customer experience, insurer relationships and medical servicing, with the mandate to create one of the strongest health insurance servicing platforms in the market.
