Senior Manager

Department:

Key Responsibilities:

• Claims Assessment:

  Evaluate and process health insurance claims in accordance with policy terms and conditions.

• Medical Review:

  Identify and flag potential cases of medical abuse or discrepancies in treatment protocols.

• Admissibility Decision:

  Determine claim eligibility based on thorough review of medical documentation and policy guidelines.

• Tariff Adjudication:

  Review and authorize cashless approvals, ensuring alignment with applicable tariffs and negotiated rates.

• Stakeholder Coordination:

  Liaise effectively with internal teams, network hospitals, and other external stakeholders to ensure smooth claim processing and resolution.

Qualifications & Skills:

• MBBS/BAMS/BHMS/BDS or equivalent medical qualification (preferred).
• Strong understanding of health insurance policies and medical terminology.
• Analytical mind-set with attention to detail.
• Excellent communication and decision-making skills.
• Ability to work collaboratively in a fast-paced environment.
• Flexible to work in rotational shifts

Experience Required:

Preferred candidate profile