Healthcare Operations Manager
1 week ago
CarePal Group is revolutionizing healthcare financing in India by providing innovative solutions that make critical and elective treatments more accessible and affordable.
Through our platforms, we aim to empower people with financial tools to secure essential healthcare.
Job SummaryThe Healthcare Operations Manager - Trust and Safety will drive CarePal Group's trust and safety strategy, overseeing hospital coordination, insurance claim processing, and TPA operations.
Key Responsibilities- Hospital Coordination: Manage relationships with hospital billing departments to ensure seamless service coordination. Oversee admission, discharge, and cost verification processes, ensuring adherence to CarePal's pricing agreements.
- Billing Verification & Reconciliation: Conduct cost verification and reconciliation with hospital billing & Finance teams to prevent discrepancies and ensure adherence to agreed rates.
- Patient Journey & Health Insurance Coordination: Oversee the full patient journey from admission through discharge, ensuring compliance with healthcare insurance guidelines.
- Patient Background Verification: Manage patient background verification processes, ensuring accurate information validation.
- TPA Operations & Insurance Claim Management: Lead TPA operations, focusing on claims processing, insurance documentation, and patient eligibility verification.
- Fraud Prevention & Risk Management: Oversee insurance claim processes, implementing fraud detection and prevention strategies.
- Policy Development & Compliance: Develop policies to uphold trust and safety in patient operations, aligning with healthcare and insurance standards.
- Risk Analysis & Escalation Management: Conduct risk assessments to identify potential issues, especially in hospital coordination, TPA processes, and patient verification.
- Bachelor's degree in healthcare management, business administration, or a related field. MBA or equivalent advanced degree preferred.
- 10+ years of experience in Health Insurance, claim processing, with a focus on TPA management, hospital coordination, and billing.
- Demonstrated success in managing healthcare insurance claims, billing verification, and trust and safety protocols.
Estimated Salary: ₹1,200,000 - ₹1,500,000 per annum.
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