*For Pooling Purposes*
- Provide consultancy services to the insurance and healthcare vertical to set up the clinical/bill review/insurance practice.
- Establish and maintain communication with clients and/or team members; understand their needs, resolve issues, and meet their expectations.
- Participate in RFPs, client proposals, client meetings & sales calls as directed by the supervisor.
- Produce solid and effective strategies based on accurate and meaningful data reports and analysis and/or keen observations that would impact business outcomes.
- Identify the training needs that will equip the staff with fundamental skills and knowledge for the clinical/bill review/insurance programs.
- Have a thorough understanding of the various system tools and operational procedures utilized within the program and provide guidance/recommendations to the operations team on improving service delivery/outcomes.
- Collaborate with stakeholders on a regular basis for creating strategies.
- Conduct all defined and required process compliance and adherence to all team members, partners, and third-party providers for clinical insurance program and provide recommendations to improve the framework/rectify the identified gaps.
- Earned a bachelor’s degree in any related field.
- Registered Nurse (PH & US Licensed).
- At least 15 years of work experience in the same industry with 2-3yrs of Director experience.
- Proven experience in the healthcare/casualty/worker's compensation domain managing processes such as Intake, Clinical Utilization Review, Nurse Reviews, Medical Provider Call Center.
- Excellent working knowledge on Microsoft Office applications.
- Ability to efficiently manage time and keep track of multiple schedules, meetings, and initiatives.
- Strong analytical skills.
- Demonstrated leadership skills.
All your information will be kept confidential according to EEO guidelines.