Manager Medical Operations & Insurance

Role & responsibilities

* Manage cashless admissions, pre-authorisation, enhancements and discharge approvals

* Review medical records and ensure clinical justification for insurance claims

* Coordinate with TPAs and insurers on queries, rejections, deductions and pending cases

* Coordinate with consultants, RMOs, nursing, billing and other departments across OPD, IPD and Emergency

*Conduct medical audits and support NABH compliance

* Train doctors and staff on insurance documentation, and improve approval and discharge TAT

Who we are looking for:

* Hospital-based clinical experience

* Exposure to Insurance/TPA operations (preferred)

* Experience in cashless patient management, claim management and medical audits

* Working knowledge of HIS/HMS

* Strong communication, coordination and problem-solving skills

Priority given to candidates with: clinical hospital experience + TPA/insurance exposure + cashless and claims knowledge + audit and documentation experience.

Preferred candidate profile