Senior Manager

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 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: 4-5 years in Health Insurance Claims/Underwriting/Investigation etc. fresher with clinical skills also ok