Manager - Health Claims

As a Clinical Manager at Care.fi, a Health fintech startup in Gurgaon, you will play a crucial role in driving the clinical backbone of the revenue cycle operations. Your responsibilities will include: - Leading and scaling a team of medical professionals involved in claim audits and clinical validations. - Defining clinical protocols, ensuring adherence to quality and compliance standards, and driving continuous improvement. - Acting as the clinical authority for complex case reviews and appeals. - Guiding hospital teams to resolve documentation gaps and strengthen case submissions. - Identifying patterns in denials, leading root-cause audits, and implementing corrective action strategies. - Collaborating with the tech team to co-build AI-driven clinical validation tools. - Structuring clinical logic and data points that power LLMs and automation engines. - Advocating adoption of digital tools that improve documentation accuracy and reduce manual overhead. Qualifications required for this role include: - 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.,