Job Description: Team Lead – Medical Insurance Operations
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 daily operational activities, team performance, inventory allocation, and medical case processing.
The ideal candidate should have 3–5 years of relevant experience in health insurance, TPA operations, claims processing, and/or pre-authorization. This role requires a hands-on medical professional who can effectively manage team operations while independently handling medical cases, with approximately 50% of the role dedicated to individual case processing.
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 case processing.
- Independently handle claims and/or pre-authorization cases, dedicating approximately 50% of working time to individual processing.
- Review medical records, clinical documentation, treatment plans, and supporting documents to assess medical admissibility in accordance with policy terms and client guidelines.
- Provide medical and process-related guidance to team members and assist in resolving complex cases.
- Monitor individual and team performance, identify productivity gaps, and implement corrective action plans.
- Ensure compliance with SOPs, client guidelines, insurance policy terms, quality standards, and applicable regulatory requirements.
- Monitor ageing cases, prioritise TAT-critical inventory, and proactively prevent SLA breaches.
- Manage operational escalations and coordinate with internal stakeholders for timely resolution.
- Conduct team huddles, knowledge-sharing sessions, and refresher training to improve processing accuracy and productivity.
- Analyse quality errors and recurring issues and implement corrective and preventive actions.
- Prepare and maintain daily reports on productivity, quality, TAT, inventory, and pending cases.
- Identify process improvement opportunities to enhance operational efficiency and service delivery.
Required Qualifications and Experience
- MBBS / BHMS / BAMS from a recognised institution.
- 3–5 years of relevant experience in health insurance, TPA operations, claims processing, or pre-authorization.
- Prior experience in team coordination, floor support, mentoring, or team handling is preferred.
- Sound understanding of medical documentation, medical necessity, policy benefits, exclusions, and insurance processing guidelines.
- Experience in productivity monitoring, inventory management, quality control, and TAT/SLA adherence.
Required Skills
- Strong medical assessment, analytical, and decision-making skills.
- Team management, mentoring, and work allocation.
- Inventory, backlog, and workload management.
- Excellent problem-solving and escalation-handling abilities.
- Good communication and interpersonal skills.
- Proficiency in MS Excel and operational reporting.
- Ability to work in a target-driven environment while maintaining quality standards.
- Flexibility to work in rotational shifts based on business requirements.
What We Are Looking For
A hands-on medical professional with strong operational ownership, proven team coordination abilities, and a commitment to delivering high productivity, processing accuracy, quality, and service excellence.
Pay: Up to ₹60,000.00 per month
Benefits:
- Paid sick time
- Paid time off
- Provident Fund
Ability to commute/relocate:
- Whitefield, Bengaluru, Karnataka: Reliably commute or planning to relocate before starting work (Required)
Application Question(s):
- Can you come for face-to-face interview?
Education:
- Bachelor's (Required)
Experience:
- TPA: 3 years (Required)
Shift availability:
- Day Shift (Required)
- Night Shift (Required)
- Overnight Shift (Required)
Work Location: In person
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