Requirements
QualificationsBachelor's degree in Medicine (MBBS/MBBCh).Minimum 5 years of experience in medical insurance, managed care, or healthcare administration.Minimum 2 years of leadership experience managing a medical approval team.Strong clinical decision-making and medical judgment.Excellent knowledge of medical insurance policies, benefit structures, and utilization management.Strong analytical, leadership, and problem-solving skills.Excellent communication and stakeholder management abilities.Ability to work effectively under pressure in a fast-paced environment.
Description
About the RoleWe are seeking an experienced and highly motivated Medical Approval Supervisor to lead our Medical Approval Department. The successful candidate will be responsible for managing the medical approval team, ensuring timely and accurate authorization decisions, maintaining service level agreements (SLAs), and driving continuous improvement in medical operations while delivering an exceptional client experience.Lead, coach, and develop the Medical Approval team.Ensure prompt and accurate medical authorization decisions in accordance with policy terms and clinical guidelines.Monitor team performance and ensure compliance with departmental KPIs and SLAs.Review complex and escalated medical cases and provide clinical guidance.Develop, implement, and continuously improve approval policies, workflows, and standard operating procedures.Analyze approval trends and recommend initiatives to improve efficiency and quality.Collaborate with Provider Relations, Case Management, Claims, Customer Service, and Account Management teams to resolve operational issues.Ensure compliance with regulatory requirements and internal quality standards.Prepare periodic operational and performance reports for senior management.Conduct quality audits and implement corrective actions where needed.Participate in client meetings when medical expertise is required.Support digital transformation initiatives and process automation within the department.