Job Purpose

To lead and manage the Pre-Authorization/Claims floor by ensuring timely and accurate processing of requests, driving productivity and compliance, resolving escalations, and maintaining service excellence for insurers, hospitals, and customers.

Principal Accountabilities

1. Ensure timely adjudication of pre-authorization/Claims requests ? meet defined TAT and service levels.
2. Monitor and guide medical officers ? achieve productivity and quality benchmarks.
3. Validate medical decisions and documentation ? ensure accuracy and compliance with policies.
4. Coordinate insurer concurrence and approvals ? reduce delays and errors in processing.
5. Resolve escalations promptly ? maintain hospital/insurer satisfaction and minimize disputes.
6. Track and report performance metrics ? enable continuous improvement and accountability.

Reporting Structure:

Reporting to – Head – Pre Authorization

Major Challenges

- Managing high value cases while ensuring accuracy.
- Balancing hospital, insurer, and internal teams.
- Driving team performance in a 24/7 rotational shift work.





Decisions

- Approving/rejecting complex pre-authorization cases within defined authority.
- Escalating cases requiring higher-level clinical or insurer intervention.
- Prioritizing workload to meet urgent TAT requirements.

Interactions

Internal: Doctors, CRM team, Operations team, IT/Systems support.
External: Hospitals, Insurers, Brokers, Customers.

Dimensions

- Team Size Managed:
- Case Volume:
- Shift Coverage: 24/7 rotational shift management.

8. Skills & Knowledge

Education: BDS/BHMS/BAMS/MBBS

Experience: 3–10 years in Health Insurance / TPA with exposure to pre-authorization and team management.

Technical Skills: Solid knowledge of medical terminology, hospitalization processes, and health insurance policies, proficiency in MS Office and Pre Auth/Claims management systems.

Leadership Skills: People management, communication, problem-solving, decision-making under pressure.

📌 Manager - Preauth/Claims - chennai Location- NHIS TN
🏢 Vidal Health Insurance TPA
📍 Chennai