Director of Claims and Tariff Management at Reliance HMO

Key Responsibilities

• Cost Reduction and Fast Reimbursement Cycles: Implement strategies to reduce costs and ensure rapid reimbursement cycles for claims across all active markets, enhancing overall operational efficiency and customer satisfaction.
• Efficiency Improvement and Unpaid Claims Reduction: Oversee initiatives to enhance the efficiency of claims and optimize team productivity and processing systems to reduce unpaid claims backlogs and streamlining workflows for faster adjudication.
• Automation and Rules-Based Claims Processing: Lead the improvement of rules-based automated claims processing engines, leveraging technology to enhance accuracy, speed, and consistency in claims adjudication.
• Prior Authorization Enhancement: Enhance the accuracy and turnaround time for complex prior authorization requests, ensuring timely access to necessary healthcare services for our members.
• Cost Reduction and Fast Reimbursement Cycles: Implement strategies to reduce costs and ensure rapid reimbursement cycles for claims across all active markets, enhancing overall operational efficiency and customer satisfaction.
• Efficiency Improvement and Unpaid Claims Reduction: Oversee initiatives to enhance the efficiency of claims and optimize team productivity and processing systems to reduce unpaid claims backlogs and streamlining workflows for faster adjudication.
• Automation and Rules-Based Claims Processing: Lead the improvement of rules-based automated claims processing engines, leveraging technology to enhance accuracy, speed, and consistency in claims adjudication.
• Prior Authorization Enhancement: Enhance the accuracy and turnaround time for complex prior authorization requests, ensuring timely access to necessary healthcare services for our members.

Requirements

• MBBS or Bachelor's Degree in Healthcare Administration, Business Management, with a preferred background of master’s level studies in data analysis or business administration  
• 8+ years of experience in claims management and tariff negotiation within the healthcare industry
• Proven track record of implementing process improvements to enhance claims efficiency and reduce costs.
• Strong background in data analysis and demonstrated ability to work with data to solve complex problems, utilizing advanced analytical tools and methodologies
• Strong understanding of rules-based automated claims processing systems and prior authorization workflows.
• Experience in tariff negotiation, provider network management, and benefits design across diverse markets.
• Excellent leadership and communication skills, with the ability to collaborate effectively across cross-functional teams.
• Analytical mindset with proficiency in data-driven decision-making and performance metrics evaluation.

Benefits
At Reliance Health, we prioritize our people and their well-being. Our benefits package is designed to support your success, growth, and happiness. Here’s what you’ll enjoy:
Hybrid, Flexible Environment:

• Experience the best of both worlds with our hybrid setup—work from home when you need focus, and connect with a vibrant, collaborative team in the office.

Competitive Salary and Benefits:

• We offer a salary that’s benchmarked against the best in the industry, ensuring your expertise and impact are fully rewarded.

Premium Health Insurance:

• Comprehensive health coverage for you and your family, because your well-being comes first.

Unlimited Leave:

• Take the time you need when you need it—no limits, no questions.

Meaningful Impact:

• Play a key role in transforming customer experiences and shaping healthcare innovation.

Collaborative Work Culture:

• Join a supportive, inclusive, and team-focused environment that celebrates diversity.

Growth Opportunities:

• Access tools, mentorship, and resources to elevate your skills and career.

Learning & Development Allowance:

• We provide an allowance to support your ongoing professional growth and skill enhancement.