AVP - Health Claims Processing - Process Improvement - Health Insurance - 6+ Years - Bangalore

AVP - Health Claims Processing - Process Improvement - Health Insurance - 6+ Years - Bangalore

We are hiring a senior leader in Health Insurance Claims Operations for the role of AVP – Process & Quality Improvement. The role is designed for professionals with strong hands-on exposure to health claims processing, operational efficiency, and quality governance, who can drive scalable and compliant claims operations in a digital-first insurtech environment.

Location: Bangalore

Your Future Employer: A leading, digital-first insurance organization, focused on process excellence, automation, and scalable operations.

Responsibilities:

1. Lead end-to-end health claims processing operations improvement across cashless, reimbursement, pre-authorization, and post-authorization workflows.
2. Drive process standardization, SOP governance, and quality control frameworks to improve claims accuracy, turnaround time, and consistency.
3. Identify process gaps, leakages, rework, and operational risks within claims and implement process improvement and automation initiatives.
4. Execute Lean Six Sigma / DMAIC-based projects focused on productivity enhancement, defect reduction, and cost optimization.
5. Collaborate with technology, product, and automation teams to digitize claims workflows and improve straight-through processing (STP).
6. Track claims KPIs, quality metrics, audit findings, and regulatory compliance, and present insights and improvement outcomes to senior leadership.

Requirements:

1. Strong experience in Health Insurance Claims Processing operations within an insurer, TPA, or insurtech organization.
2. Proven background in Process Excellence, Operational Excellence, or Quality Improvement roles within health claims.
3. Hands-on expertise in Lean Six Sigma methodologies such as DMAIC, VSM, FMEA, and Root Cause Analysis.
4. Exposure to claims automation, digital workflows, OCR, rule engines, or tech-enabled claims platforms.
5. Sound understanding of health insurance regulations and compliance requirements (IRDAI; HIPAA exposure preferred).
6. Ability to influence cross-functional stakeholders and drive change in a fast-paced, high-growth environment.

What’s in it for you?

• Opportunity to build and scale best-in-class health claims operations
• High-visibility role in a fast-growing, confidential insurtech setup
• Work closely with leadership on claims automation and quality transformation
• Long-term career growth in a technology-driven insurance ecosystem

Reach Us: If you feel this opportunity is well aligned with your career progression plans, please feel free to reach me with your updated profile at vanika.arora@crescendogroup.in for a confidential discussion on the role.

Disclaimer: Crescendo Global specializes in Senior to C-level niche recruitment. We are passionate about empowering job seekers and employers with an engaging, memorable job search and leadership hiring experience. Crescendo Global does not discriminate on the basis of race, religion, color, origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

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Keywords: Health Claims Processing, Claims Operations, Health Insurance, Insurtech, Process Excellence, Quality Improvement, Lean Six Sigma, DMAIC, Claims Automation, AVP