Location: Bengaluru
Experience: 3–5 Years
Qualification: MBBS / BHMS / BAMS
Work Schedule: 5 Days a Week | Rotational Shifts
Industry: Health Insurance / TPA / Healthcare Operations

Job Summary

We are looking for a proactive and result-oriented Team Lead – Medical Insurance Operations to manage day-to-day operations, team performance, inventory allocation, and medical case processing.

Candidate should have 3–5 years of experience in the medical insurance/TPA industry, with sound knowledge of medical adjudication, claims processing, and/or pre-authorization. The role requires a hands-on skilled who can effectively manage a team while actively contributing to individual processing targets.

Key Responsibilities

- Manage day-to-day team operations and ensure achievement of productivity, quality, and turnaround time (TAT) targets.
- Monitor incoming inventory, allocate cases, manage pending workloads, and ensure timely processing of cases.
- Personally handle Claims/Preauth case processing, accounting for approximately 50% of the role's working capacity.
- Review medical records, clinical documentation, treatment plans, and supporting documents to assess medical admissibility in line with policy terms and client guidelines.
- Provide medical and process-related guidance to team members and support resolution of complex cases.
- Monitor individual and team performance, identify productivity gaps, and implement improvement plans.
- Ensure adherence to SOPs, client instructions, insurance policy conditions, quality standards, and regulatory requirements.
- Monitor ageing cases, prioritise TAT-critical inventory, and proactively prevent SLA breaches.




- Handle operational escalations and coordinate with internal stakeholders for timely resolution.
- Conduct team huddles, knowledge-sharing sessions, and refresher training to improve team performance and processing accuracy.
- Analyse quality errors and recurring issues and implement corrective and preventive actions.
- Prepare and maintain daily productivity, quality, TAT, and inventory reports.
- Identify opportunities for process improvement and operational efficiency.

Required Qualifications and Experience

- MBBS / BHMS / BAMS from a recognised institution.
- 3–5 years of relevant experience in medical insurance, health insurance TPA operations, claims processing, or pre-authorization.
- Prior experience in team coordination, floor support, mentoring, or team handling is preferred.
- Good understanding of medical documentation, medical necessity, policy benefits, exclusions, and insurance processing guidelines.
- Knowledge of productivity monitoring, inventory management, quality control, and TAT/SLA adherence.

Required Skills

- Strong medical assessment and analytical skills.
- Team management and work allocation.
- Inventory and backlog management.
- Excellent problem-solving and decision-making abilities.
- Good communication and interpersonal skills.
- Proficiency in MS Excel and operational reporting.
- Ability to work in a target-driven environment.
- Willingness to work in rotational shifts with flexibility based on business requirements.

What We Are Looking For

A hands-on medical professional with strong operational ownership, the ability to lead and motivate a team, and a commitment to maintaining high standards of productivity, quality, and service delivery.

📌 Claims - Team Lead (Bengaluru)
🏢 Vidal Healthcare Services
📍 Bengaluru