Job Description: Assistant Manager - Operations

Role Overview

- Job Title: Team Lead / Assistant Manager - Enforcement (Field Role)
- Department: Provider Partnerships
- Employment Type: Full-time

Position Summary

The Team Lead / Assistant Manager - Enforcement will play a critical role in ensuring

financial integrity and compliance across our provider network. This is a agile, field

- oriented leadership role where you will investigate suspicious claims, negotiate billing

blends deep clinical/billing knowledge with strong negotiation skills to protect business

interests while maintaining healthy partnership ecosystems.

Key Responsibilities

1. Claims Review & Forensic Analysis
- Critically review and analyze flagged medical claims to identify instances of

overbilling, fraud, waste, abuse (FWA), or deviations from contractual tariffs.

- Document investigative findings, trends, and claim discrepancies with high precision

and audit-ready clarity.

1. Hospital Engagement & Dispute Resolution
- Act as the primary point of contact for hospital billing teams and treating physicians

to communicate, negotiate, and resolve billing discrepancies.

- Conduct targeted hospital field visits to resolve complex disputes, audit on-site

records, and drive positive provider engagement.

- Ensure swift, structured settlement of overcharged claims and maintain meticulous

records of all hospital interactions.

1. Tracking, Governance & Reporting
- Oversee and maintain internal dashboards and trackers monitoring recoveries,

refunds, and adjustments.

- Formally handle escalations, issuing official communications or show-cause notices

to non-compliant providers when necessary.

- Provide strategic,



data-driven updates to senior management on enforcement progress

and recovery targets.

Requirements & Qualifications

Education

- Preferred: Bachelor’s or Master’s degree in Healthcare Administration, Hospital

Management, Nursing, or Clinical streams (BDS, BHMS, and BAMS).

Experience

- 2-4 years of core experience within the healthcare ecosystem (Hospitals, Health

Insurance Companies, or TPAs).

- Proven track record in hospital billing, medical auditing, or claims processing.
- Prior experience in provider network management, fraud enforcement, or insurance

operations is highly advantageous.

Core Skill Sets

- Domain Expertise: Deep understanding of medical terminology, hospital workflows,

billing structures, and insurance claims processes.

- Negotiation & Strategy: Exceptional negotiation skills with a professional, strategic

approach to conflict resolution with hospital management.

- Analytical Skills: High proficiency in MS Excel and data-driven reporting to track

KPIs and identify billing trends.

- Communication: Flawless verbal and written communication skills in English as

well as the relevant regional language(s).

- Attributes: Sharp attention to detail, proactive problem-solving ability, and the

capacity to operate independently in a field environment.

Operational Note: > As this is a critical enforcement and relationship-driven role,

must demonstrate high adaptability, a continuous learning mind-set, and a willingness to take

on new strategic tasks as needed.

Job Types : Full-time, Permanent

Pay: ₹300,000.00 - ₹600,000.00 per year

Benefits :

- Health insurance
- Provident Fund

Application Question(s):

- Current CTC
- Expected CTC

Experience :

- total work: 5 years (preferred)

Work Location: In person

📌 Assistant Manager -provider Partnership (Bagh)
🏢 MEDI ASSIST INSURANCE TPA PRIVATE
📍 Bagh