Manager - Health Claims

As a Clinical Manager at Care.fi, a Health fintech startup in Gurgaon, you will be responsible for leading the clinical backbone of revenue cycle operations. Your role will involve guiding a team of medical experts to ensure precision in claim validation, reduce denials, and enable accurate documentation. You will blend clinical insight with operational excellence and innovation, especially in the development of cutting-edge tools using AI and machine learning. **Key Responsibilities:** - 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. - 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. - Collaborate with the tech team to co-build AI-driven clinical validation tools. - Structure clinical logic and data points that power LLMs and automation engines. - Advocate adoption of digital tools that improve documentation accuracy and reduce manual overhead. **Qualifications Required:** - 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. This role at Care.fi offers you the opportunity to contribute to the seamless financing and revenue cycle management solutions for healthcare providers, leveraging your clinical expertise and passion for technology-driven innovation.,