Senior Manager – Clinical Insurance Operation

Job description

AVP / Senior Manager – Clinical Insurance Operations (Doctor Only)

Location: Mumbai

Positions: 1

Salary: ₹1 Lakh per month

Role Overview

This is a specialized role requiring a medical professional to oversee clinical aspects of insurance operations, including claims validation and medical underwriting support.

Key Responsibilities

1. Evaluate medical aspects of insurance claims
2. Liaise with hospitals and medical teams for case validation
3. Support underwriting and claims teams with clinical insights
4. Review treatment protocols and hospitalization cases
5. Ensure compliance with medical and insurance guidelines
6. Assist in fraud detection and medical audits
7. Improve clinical processes within insurance operations

Requirements

1. MBBS & BHMS preferred
2. 5+ years of experience in hospital/TPA/insurance
3. Strong understanding of health insurance claims
4. Experience in clinical audits or insurance operations preferred
5. Analytical and decision-making skills