Health Insurance Contract & Claims Manager
Core
Oversee administration of health insurance contracts and manage the end-to-end claims process, including investigation, settlement negotiation, and fraud detection for a multi-specialty medical institution.
Role type
Senior IC health insurance contract and claims manager
Builds
Insurance contracts, reinsurance treaties, and claim settlements for patients and partners
Domain
Healthcare + Insurance
Deliverable
client delivery
Required skills
Insurance policy interpretation, claims investigation, settlement negotiation, risk assessment, reinsurance management, regulatory compliance, contract drafting, fraud detection
Preferred skills
MBA in finance/risk/insurance, Chartered Insurance Institute qualification
Technologies
None stated
Responsibilities
Interpret insurance policies to determine coverage and exclusions; oversee claims from notification to settlement; negotiate settlements with claimants; monitor and mitigate insurance risks; manage reinsurance programs and recoveries; investigate potential fraud; draft and finalize insurance contracts; ensure compliance with licensing and solvency requirements
Seniority
Senior, hands-on IC with team leadership