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

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.