Head of Value Management

A Leading Health Insurance Group is seeking a strategic Head of Value Management to lead claims cost diagnostics and network economics in Mumbai. In this executive leadership position, you will assume full P&L stewardship over claims management across both Retail and Group insurance portfolios. Furthermore, you will drive hospital package renegotiations, cashless mix shift strategies, and provider loss ratio governance. Consequently, this role is critical for curbing medical inflation, eliminating claims leakage, and protecting underwriting profitability.

The Head of Value Management must combine extensive healthcare analytics expertise with strong commercial negotiation and actuarial collaboration skills. Working closely with Product, Pricing, Distribution, and Underwriting headers, you will translate claims data into actionable product features, deductibles, co-pays, and distribution sales scorecards. Therefore, the organization is looking for a data-driven leader who establishes single-source-of-truth claims integrity and detects fraud, waste, and abuse systematically. If you want to steer enterprise healthcare economics, this role offers an elite platform.

Key Responsibilities

• Assume P&L stewardship for claims management, optimizing the claims ratio as a core financial line across Retail and Group lines.
• Forecast portfolio claims ratios and future claims costs aligned with corporate planning, competition benchmarking, and pricing parameters.
• Deconstruct healthcare claims expenses into actionable cost drivers: utilization frequency, average claim size, tariff structures, and leakage.
• Isolate medical inflation from controllable operational factors to design effective cost-containment interventions.
• Lead network hospital renegotiations, structured package deals, spot pricing discussions, and cashless adoption strategies.
• Direct the Claims Control Desk to enforce benefit-level governance, payable rule integrity, and audit compliance.
• Oversee Fraud, Waste & Abuse (FWA) detection engines across provider networks, third-party administrators, and distribution channels.
• Partner with Actuarial teams to feed empirical claims insights into sum insured ladders, riders, deductibles, and co-pay pricing decisions.
• Establish a reconciled claims single source of truth across customer records, diagnostic codes, procedures, and provider billings.

Requirements and Qualifications

• Bachelor’s or Master’s degree in Healthcare Management, Actuarial Science, Business Administration, Economics, or Medicine.
• 10-12 Years of senior leadership experience in Health Insurance, Healthcare Analytics, or Claims Management.
• Proven track record in claims P&L management, hospital network negotiations, tariff restructuring, and healthcare cost diagnostics.
• Strong commercial acumen in detecting fraud, waste, and abuse, with experience embedding loss-ratio scorecards into sales channels.
• Exceptional executive communication, data governance, and cross-functional leadership capabilities.