Manager - Healthcare Services

Job Description To resolve internal escalations of non-approved pre-authorization cases on time and restore member confidence through clear communication and coordinated clinical review. End-to-End Escalation & Recovery Case Management Handle internal escalations of non-approved pre-authorization cases. Coordinate clinical review of escalated cases. Coordinate with Medical, Operations and Customer Care to resolve cases on time. Track open escalations to control the case backlog. Member Recovery & Service Excellence Conduct recovery reviews for predefined eligible cases. Contact members to understand and address their concerns. Communicate case outcomes to members clearly. Follow up after adverse service experiences to restore member confidence. Continuous Improvement & Root Cause Analysis Analyse escalations, complaints and rework drivers to identify root causes. Identify process gaps and improvement opportunities. Recommend corrective and preventive actions for approval. Coordinate agreed actions with cross-functional stakeholders. Skills Healthcare insurance operations and pre-authorization processes Medical policy and benefit interpretation Case management and service recovery methodologies Customer experience and complaint management Healthcare analytics and performance reporting Quality assurance and root cause analysis Process improvement and operational excellence Data visualization and dashboard interpretation Risk assessment and escalation management Communication, stakeholder management and negotiation skills Education Medicine and Surgery Show more Show less