Chief Operations Officer, Trust and Safety

2 weeks ago

Mumbai, Maharashtra, India Talent Destination Full time
About the Role

We are seeking a seasoned Chief Operations Officer to lead our Trust and Safety team at Talent Destination. This is a pivotal role that demands strategic thinking, exceptional leadership, and a deep understanding of healthcare insurance operations.

Job Summary

The successful candidate will drive our trust and safety strategy, overseeing hospital coordination, insurance claim processing, and TPA operations. With a strong focus on process improvement and risk management, this individual will ensure seamless service coordination, accurate billing verification, and efficient patient journeys.

Main Responsibilities
  • Hospital Coordination:
    • Manage relationships with hospital billing departments to ensure smooth service delivery
    • Oversee admission, discharge, and cost verification processes to ensure adherence to CarePal's pricing agreements
    • Lead efforts to streamline billing accuracy, optimize reconciliation processes, and enhance the patient experience
  • Billing Verification & Reconciliation:
    • Conduct cost verification and reconciliation with hospital billing & Finance teams to prevent discrepancies and ensure adherence to agreed rates
    • Develop structured reconciliation processes to accurately track and validate patient costs
    • Identify opportunities for cost-saving and process improvement in billing workflows
  • Patient Journey & Health Insurance Coordination:
    • Oversee the full patient journey from admission through discharge, ensuring compliance with healthcare insurance guidelines
    • Coordinate with TPA and hospital teams for seamless admission, discharge, and insurance claim processes
    • Ensure all insurance-related processes are efficient, accurate, and meet regulatory standards
  • Patient Background Verification:
    • Manage patient background verification processes, ensuring accurate information validation
    • Implement standardized procedures for patient verification, proactively identifying and resolving discrepancies
    • Maintain high standards of trust and safety by ensuring complete and accurate patient onboarding till claim settlement
  • TPA Operations & Insurance Claim Management:
    • Lead TPA operations, focusing on claims processing, insurance documentation, and patient eligibility verification
    • Collaborate with TPA providers and insurance companies to ensure streamlined workflows and compliance
    • Enhance TPA operations by optimizing processes, reducing processing times, and improving patient satisfaction
  • Fraud Prevention & Risk Management:
    • Oversee insurance claim processes, implementing fraud detection and prevention strategies
    • Regularly monitor and audit for fraud risks, addressing any detected anomalies
    • Maintain high standards of trust by managing systems that prevent fraudulent activities in patient billing and insurance claims
  • Policy Development & Compliance:
    • Develop policies to uphold trust and safety in patient operations, aligning with healthcare and insurance standards
    • Regularly update policies to comply with regulatory changes and industry trends
    • Ensure strict adherence to data privacy laws, healthcare regulations, and insurance guidelines across all operations
  • Risk Analysis & Escalation Management:
    • Conduct risk assessments to identify potential issues, especially in hospital coordination, TPA processes, and patient verification
    • Lead escalation protocols to resolve trust and safety concerns promptly in collaboration with hospital and insurance partners
    • Regularly review processes to minimize risk and maintain high standards of operational integrity
  • Data Analysis & Reporting:
    • Utilize data analytics to track operational trends, identify areas for improvement, and monitor patient satisfaction
    • Prepare regular reports on trust and safety metrics, incident outcomes, and fraud prevention results for executive leadership
    • Use data insights to refine processes, enhance efficiency, and guide strategic decision-making
  • Team Leadership & Development:
    • Lead and mentor the Trust & Safety team, fostering a culture of accountability, integrity, and excellence
    • Ensure team members are well-trained in trust and safety protocols, billing verification, and insurance claims processes

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