Assistant Manager - Financial Operations (Health Insurance)

FinOps - Assistant Manager

Location: Indore,Madhya Pradesh,India

Job Title: Assistant Manager
Department: Health Insurance Operations
Location: Indore
Reports To: Group Manager

Key Responsibilities:
Team Leadership and Management:
Lead and manage a team of Associates/Senior Associates, providing guidance and support to
ensure effective performance.
Conduct regular team meetings and performance reviews, fostering a collaborative and
productive work environment.

Insurance Eligibility Oversight:
Oversee the process of checking insurance eligibility, ensuring compliance with health insurance
terminologies such as Sum Insured, Balance Sum Insured, Room Eligibility, Capping/Sublimit,
Coverage, and Non-Medical Expenses (NME).
Evaluate and implement strategies to explore corporate-based insurance eligibility.
Pre-Auth Document Validation and Adjudication:
Supervise the validation and adjudication of pre-authorization documents.
Ensure timely sharing of necessary documents with hospitals and effective follow-up on
pre-authorization requests.

Approval and Communication:
Ensure the internal tool is updated with approvals from hospitals.
Oversee financial counseling provided to patients, coordinating with the CB (Customer/Billing)
team as needed.

Hospital Alignment:
Facilitate alignment with hospitals to prevent miscommunication.
Confirm that hospitals conduct financial counseling, obtain patient consent, and share signed
copies with the MB Financial Operations team.

Query Resolution:

Ensure timely and effective resolution of queries for all cases, providing guidance to the team as
necessary.

Pre-Auth and Claim Rejections:
Manage the process of sharing pre-auth rejection cases with IS TLs for cash and EMI
counseling.
Guide the team in persuading patients to opt for cash or EMI options for claim rejections,
explaining these options clearly.

Discharge Process Management:
Oversee the review of discharge documents before sharing with the TPA, ensuring room
eligibility, tariff accuracy, and genuine billing.
Address TPA queries promptly and provide clear justifications to minimize repeated or multiple
queries.
Ensure hospitals collect out-of-pocket (OOP) payments as per discharge approvals.

Monitoring and Communication:
Monitor communication channels for concerns raised by hospitals and the Inside Sales Team.
Assist Inside Sales in document collection and sharing, ensuring cases are properly raised in
Lead Square.

Requirements:
Medical Background: Strong understanding of medical terminology and procedures.
Experience in Hospital Billing and Insurance: Extensive familiarity with hospital billing
processes and insurance claims.
TPA Insurance Expertise: Proven experience as a single point of contact for TPA insurance
processes.

Preferred Qualifications:
Strong leadership, communication, and interpersonal skills.
Ability to work collaboratively with hospitals, patients, and internal teams.
Proficiency in using financial and healthcare management tools.
Excellent attention to detail and problem-solving skills.

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Experience Level

Mid Level