Senior Manager-New Business (Medical and Scrutiny Management)

Role Overview:

This role is responsible for ensuring operational excellence in medical and scrutiny processes, managing TPA relationships, and driving automation initiatives. The role focuses on compliance, efficiency, and stakeholder engagement to deliver a seamless pre-issuance experience.

Key Focus Areas:

Operational KPI Management

• Ensure daily operational KPIs are met, including medical completion TAT, scrutiny, and pendency management.
• Monitor performance dashboards and implement corrective actions.
• Stakeholder Coordination
• Coordinate with internal teams, clients, and external stakeholders for TPA and scrutiny-related queries and clarifications.
• Maintain effective communication channels for timely resolution.
• TPA Exception Handling & Escalations
• Monitor TPA exceptions and handle high-value escalations.
• Ensure timely resolution and maintain service quality standards.
• Process Optimization & Automation
• Identify process bottlenecks and lead cross-functional initiatives to automate and streamline scrutiny and TPA workflows.
• Collaborate with technology teams for implementation.
• TPA Performance Monitoring
• Track and review TPA performance against defined SLAs and TAT.
• Share periodic performance reports with stakeholders.
• TPA Empanelment & Governance
• Handle empanelment, mystery shopping, and periodic renewal of TPA partners.
• Ensure compliance with contractual and regulatory requirements.

Assisted PIVV & Welcome Calling

• Track efficiency of Assisted PIVV and Welcome calling processes.
• Ensure adherence to quality and compliance standards.
• Commercial & Billing Management
• Monitor commercial terms, validate billing, and reconcile invoices.
• Ensure accuracy and adherence to financial governance.
• Escalation Management
• Manage escalations related to medical and scrutiny processes.
• Implement preventive measures to reduce recurrence.
• Assisted PIVV & Welcome Calling
• Track efficiency of Assisted PIVV and Welcome calling processes.
• Ensure adherence to quality and compliance standards

Qualifications & Competencies:

• Graduate/Post graduate with atleast 6-8 years relevant experience in Medical & Scrutiny Management from Life or Health Industry
• Excellent communication & stakeholder management skills