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 dynamic, field-
oriented leadership role where you will investigate suspicious claims, negotiate billing
corrections directly with hospitals, and manage provider relationships. The ideal candidate
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.
2. 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.
3. 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,
responsibilities may evolve based on dynamic business requirements. The ideal candidate
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):
Experience:
- total work: 5 years (Preferred)
Work Location: In person
