Job Specifications BAMS/BHMS/MBBS with Post graduation /Healthcare Management Professional Experience years of Experience in a tertiary care hospital or Health Insurance sector Main Objective of the Role To Ensure compliance to complete End to End claim processing, disbursement and settlement for All insurance and corporate Patients Key Responsibilities Medical Claims Compliance & Processing Oversight Ensure 100% compliance in claims processing through the IHX portal. Monitor the complete end-to-end lifecycle of claims management, including disbursal and settlement. Supervise and review daily, weekly, and monthly claims data: claims raised, under query, pending/disputed, and ageing analysis. Assist local TPA teams in resolving stuck or disputed claims. Ensure claims are settled in line with the agreed MoU with partners and corporates. Monitor and control disallowances and short payments after final approvals. Supervise the claim settlement process within the HMIS system. Liaise, engage, and coordinate with insurance companies and TPA partners. Claims Audit & Quality Assurance Perform detailed audits of medical claims to ensure accuracy and integrity. Review and verify diagnosis codes, treatment plans, and medical necessity. Identify and rectify errors, discrepancies, or potential fraud in claims submissions. Prepare comprehensive audit reports with findings, recommendations, and corrective actions. Maintain accurate and complete records of audits and corrective measures. Process Improvement & Compliance Develop and implement efficient claims processing procedures and controls to enhance accuracy and operational efficiency. Monitor and analyze claims trends and processing metrics to identify improvement areas. Ensure adherence to regulatory requirements and best practices. Collaborate with internal teams to refine policies and procedures for claims adjudication. Assist in the development and review of medical policies, clinical guidelines, and criteria for adjudication.

Job Specifications • Bachelor's in Pharmacy, Logistics, Supply Chain Management, or related field. • MBA or Master's in Healthcare/Operations Management (preferred). Professional Experience 15+ years of experience in supply chain roles, with 5+ years in a leadership role preferably in a healthcare setting Main Objective of the Role To coordinate centralized supply chain operations across the hospital network by standardizing procurement, streamlining logistics, and ensuring optimal inventory levels at all locations. The role is critical in enabling cost efficiency, quality assurance, and uninterrupted medical service delivery across all units. Key Responsibilities Centralized Procurement Strategy Supervise and implement centralized procurement policies across all hospitals/units. Leverage economies of scale through bulk purchasing and framework agreements. Ensure all purchases adhere to the group’s compliance and quality standards. System-Wide Inventory Management Design and oversee a centralized inventory management system. Monitor inventory levels across all sites to balance stock distribution and avoid shortages or overstocking. Facilitate inter-unit transfer of supplies when needed. Supply Chain Standardization Establish uniform SOPs for procurement, storage, distribution, and disposal. Drive standardization of SKUs, vendor evaluation criteria, and reporting templates across the group. Work closely with IT to integrate ERP/HMIS systems across all sites. Data-Driven Forecasting & Analytics