Senior Operations Manager overseeing healthcare operations with a focus on KPIs and strategic planning. Leading teams and ensuring compliance in a hybrid role from Taguig, Metro Manila.
About the role
- Associate, Claims Operations at Reliance Health ensuring accurate healthcare claims processing and resolving inconsistencies in the claims system with clinical expertise.
Responsibilities
- Review, validate, and process healthcare claims in line with company policies
- Ensure claims are accurately recorded and maintained in the system
- Investigate complex claims and make decisions based on clinical standards and internal guidelines
- Support timely payment of approved claims within defined service timelines
- Identify and decline fraudulent or suspicious claims
- Investigate cases of fraud, waste, and abuse, and escalate findings where necessary
- Collaborate with provider management teams to resolve provider-related issues
- Share claims updates and reconciliation details with healthcare providers
- Provide clinical input on complex care approvals when required
- Support patient referral decisions in collaboration with the care team
Requirements
- Bachelor’s degree in Medicine (MBBS or equivalent)
- Minimum of 1 year clinical experience as a medical doctor
- Strong understanding of clinical procedures, terminology, and standards of care
- Ability to apply clinical knowledge to claims review and decision-making
- Strong numerical and analytical skills
- Experience working with data and processing information accurately
- Clear written and verbal communication skills
- Proficiency in Microsoft Word and PowerPoint
- Nice to Have
- Experience in claims processing or care approvals
Benefits
- Salary: EGP 16,518.19 monthly
- Hybrid role based in Cairo, Egypt
- Unlimited leave – take the time you need
- Premium health insurance for you and your family
- Learning and development allowance to support your growth
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