PHI Specialist Regulatory Escalations

About the role

Prudential Health India is building a greenfield health insurance platform in India and seeks a PHI Specialist – Regulatory Escalations to join its Customer Service team in Mumbai. The role focuses on timely, fair handling of grievances received through IGMS, Bima Bharosa Portal, PHI escalation touchpoints, social media and regulatory portals such as NCH. The specialist will manage Ombudsman and legal cases, act as the voice of the customer, and raise red flags to close gaps and improve service experience. Collaboration with Distribution, Branch, Claims, Underwriting, Legal, Medical services and TPA teams is essential to expedite resolution. The candidate must have 6‑7 years of experience, including 4‑5 years in complaints handling within health or general insurance or financial services, strong knowledge of IRDA guidelines, regulatory compliance, stakeholder management, excellent communication and negotiation skills, and a bachelor’s degree. The position is full‑time, on‑site in Mumbai, and requires a proactive, customer‑centric mindset.

What you’ll do

• Ensuring timely, fair, and effective handling of grievances received via IGMS and complaints reported to IGMS / Bima Bharosa Portal.
• Handling complaints received via PHI escalation touchpoints, social media, regulatory portals (NCH, etc) within defined turn-around-time.
• Handling Ombudsman and legal cases.
• Act as a voice of customer for PHI by raising timely red flags to fix gaps and enhance service experience.
• Collaborate with internal and external teams like Distribution, Branch, Claims, Underwriting, Legal, Medical services TPA to expedite complaint resolution.
• Be aware of all compliance related requirements.
• Participate in closure of process enhancement recommendations, risk identifications and future fixes.
• Drive service recovery initiatives to ensure enhanced customer experience and re-establish customer trust in PHI.

What you’ll bring

• 6-7 years of experience with 4-5 years of complaints handling in health insurance, general insurance or financial services industry.
• Strong knowledge of IRDA guidelines, compliance protocols and insurance related grievance mechanisms.
• Ability to manage diverse teams and stakeholders, regulatory bodies and ensure cross-functional collaboration.
• Excellent communication and negotiation skills.
• Bachelor’s degree from a recognized University.

Skills

Education

Bachelor