<h4><strong>Job Title: Senior Manager – Clinical Insurance Operations</strong></h4><h4><strong>Location:</strong> Mumbai</h4><h4><strong>Experience:</strong> 5+ Years</h4><h4><strong>Work Mode:</strong> Onsite</h4><h4><strong>Industry:</strong> Health Insurance / TPA / Healthcare</h4><h4><br /></h4><h4><strong>Job Overview</strong></h4><h4>We are hiring a qualified doctor to manage the clinical side of insurance operations. The role involves reviewing medical claims, supporting underwriting, and ensuring all cases follow proper medical and insurance guidelines.</h4><h4><br /></h4><h4><strong>Key Responsibilities</strong></h4><h4>Review and evaluate <strong>medical insurance claims</strong></h4><h4>Check <strong>hospitalization cases, reports, and treatment details</strong></h4><h4>Coordinate with hospitals and doctors for case validation</h4><h4>Support underwriting and claims teams with medical inputs</h4><h4>Ensure compliance with medical and insurance guidelines</h4><h4>Identify incorrect or suspicious claims (fraud check)</h4><h4>Assist in clinical audits and process improvements</h4><h4><br /></h4><h4><strong>Requirements</strong></h4><h4><strong>MBBS / BHMS (Mandatory)</strong></h4><h4><strong>5+ years' experience</strong> in Hospital / Insurance / TPA</h4><h4>Good knowledge of <strong>health insurance claims</strong></h4><h4>Experience in <strong>claims review or clinical audits</strong> preferred</h4><h4><br /></h4><h4><strong>Skills Required</strong></h4><h4>Strong analytical and decision-making skills</h4><h4>Good communication skills</h4><h4>Attention to detail</h4><h4>Ability to handle multiple cases</h4><h4><br /></h4><h4><strong>Preferred Profile</strong></h4><h4>Experience in <strong>insurance or TPA companies</strong></h4><h4>Exposure to <strong>fraud detection or underwriting support</strong></h4><h4><br /></h4><h4><strong>Benefits</strong></h4><h4>Fixed salary + stable role</h4><h4>Growth in insurance domain</h4><h4>Exposure to complex medical cases</h4><p><br /></p>