Senior Manager Health Management Team

Job description

Department: Health Claims (Cashless) Location: Hyderabad 1 Reporting To: Chief Manager Health Management Team 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. for 4B, Team management skills with 4-8 Yrs of experience with above skillset.