Manager - Health Claims

Job Description

Care.fi is a new age Health fintech startup in Gurgaon, offering smart financing and claim management solutions to hospitals. With a focus on driving efficiencies through technology, Care.fi provides seamless financing and revenue cycle management solution for healthcare providers. The company has strong institutional investor backing and founders with over 20 years of experience in the industry. About the Role Department: Claims Processing / Operations Reports to: Team Lead / Manager Location: Gurugram, Haryana Work Schedule: 6 Days Working; 5 days from office We’re seeking a clinically experienced and tech-curious leader to drive the clinical backbone of our revenue cycle operations. As the Clinical Manager, you will guide a team of medical experts, ensuring precision in claim validation, reducing denials and enabling accurate documentation. You’ll play a critical role in blending clinical insight with operational excellence and innovation, especially as we build cutting-edge tools using AI and machine learning. What You'll Do Clinical Strategy & Team Leadership Lead and scale a team of medical professionals involved in claim audits and clinical validations. Define clinical protocols, ensure adherence to quality and compliance standards and drive continuous improvement. Claims & Documentation Oversight Act as the clinical authority for complex case reviews and appeals. Guide hospital teams to resolve documentation gaps and strengthen case submissions. Identify patterns in denials, lead root-cause audits and implement corrective action strategies. Technology-Driven Innovation Collaborate with the tech team to co-build AI-driven clinical validation tools. Structure clinical logic and data points that power our LLMs and automation engines. Advocate adoption of digital tools that improve documentation accuracy and reduce manual overhead. What We're Looking For Minimum 5 years of clinical experience, RCM, hospital administration or claims Prior experience leading clinical/medical teams in high-performance environments Medical background (MBBS, BAMS, BHMS, BDS, B.Pharma) or a strong insurance background is preferred Deep knowledge of Indian health schemes (PMJAY, RGHS, CGHS, etc.) Ability to work cross-functionally with business, product, and tech stakeholders Strong communication, leadership and decision-making skills Show more Show less