Team Leader – Medical

Job Description

Your Role

• Oversee inpatient medical operations and ensure team productivity meets set targets and SLAs.
• Conduct daily audits of medical approvals to ensure compliance with policy coverage and procedures.
• Identify and investigate potential fraud or abuse cases from providers or clients.
• Provide medical and technical guidance to department staff and support international accounts.
• Plan and schedule manpower to optimize operational efficiency.
• Participate in regional transformation projects and support other MedNet operations when needed.
• Lead, coach, and develop staff to enhance performance and maintain processing quality.
• Review treatment plans against medical guidelines, arrange second medical opinions, and monitor admitted cases.
• Manage case steering by negotiating hospital costs, securing better treatment options, and maintaining referral matrices.
• Handle provider, client, and insurer inquiries to ensure timely resolution and service excellence.
• Prepare regular performance and medical trend reports, highlighting savings and operational outcomes.
• Maintain accurate medical records, update chronic medication reports, and ensure proper documentation filing.

Your Profile

• Bachelor’s degree in medicine.
• four years’ experience in his/her educational field.
• Experience in medical approval, call center and/or claims activities in the insurance industry or a TPA/MSO company would be a plus.
• Computer literacy (MS Office, Excel, PowerPoint)
• Good command in English
• Excellent written and verbal communication skills
• Strong leadership, planning and organizational skills
• Analytical and problem-solving skills and database management skills
• Decision making skills