Analityk biznesowy

Hiring Multiple SMEs for Core Insurance Transformation (IRDAI Expertise Required)

Location:

core health insurance platform transformation program

remote

Open SME Roles:

• Provider Management (SC02328)

• Design and streamline provider lifecycle processes (empanelment, contracting, tariffs, delisting), approval flows, data models, and integrations with claims, fraud, and finance. Strong IRDAI knowledge on provider norms is mandatory.

• Sales, Onboarding & Commission Management

• Define onboarding workflows, sales hierarchy, commission rules, compliance controls, and integration with CRM/finance. Requires familiarity with IRDAI solicitation guidelines and experience with CRM/commission systems.

• Underwriting & Medical Underwriting

• Map underwriting journeys, build rule sets, decision matrices, reinsurance triggers, and ensure alignment with IRDAI product approvals. Experience with rule engines and digital underwriting tools is preferred.

• Claims Management & TPA Interface

• Design end-to-end claims workflows (cashless & reimbursement), workload balancing rules, TPA API/EDI interfaces, escalation paths, and fraud triggers. Must have strong understanding of IRDAI claims regulations and SLA requirements.

• Policy Administration

• Define processes for issuance, renewal, upgrades/downgrades, endorsements, cancellations, and premium logic. Ensure compliance with IRDAI circulars and validate integrations with finance and customer-facing modules.

• Reporting & Regulatory

• Define IRDAI reporting frameworks, data models, mapping logic, and MIS dashboards. Lead automation of statutory filings and ensure accuracy of operational-to-financial reconciliations. Strong BI/SQL/data governance expertise required.

What We’re Looking For:

• 4–5 years SME experience in the respective domain (10–15 years for Reporting SME).
• Strong capability in

  as-is/to-be process design

  , workflow modelling, and gap analysis.
• Proven experience translating business logic into IT/system requirements.
• Background working with

  core insurance platforms

  , system configuration, and UAT.
• In-depth understanding of

  IRDAI regulations

  relevant to the domain.

Ideal Backgrounds:

Healthcare administration, insurance operations, business analysis, medical underwriting, MIS/regulatory reporting, or hands-on involvement in system transformation programs (Guidewire, TCS BaNCS, Premia, LifAsia, etc.).