Senior Manager

Job description

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