Role & responsibilities

- Manage cashless admissions, pre-authorisation, enhancements and discharge approvals
- Review medical records and ensure clinical justification for insurance claims
- Coordinate with TPAs and insurers on queries, rejections, deductions and pending cases
- Coordinate with consultants, RMOs, nursing, billing and other departments across OPD, IPD and Emergency

*Conduct medical audits and support NABH compliance
- Train doctors and staff on insurance documentation, and improve approval and discharge TAT

Who we are looking for:
- Hospital-based clinical experience
- Exposure to Insurance/TPA operations (preferred)
- Experience in cashless patient management, claim management and medical audits
- Working knowledge of HIS/HMS
- Solid communication, coordination and problem-solving skills

Priority given to candidates with: clinical hospital experience + TPA/insurance exposure + cashless and claims knowledge + audit and documentation experience.

Preferred candidate profile

📌 Manager Medical Operations & Insurance (New Delhi)
🏢 Pacific World Foundation
📍 New Delhi