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Manager

Talentmate

India

22nd October 2026

2610-6121-2604

Job Description

Works with Regional Medical Directors to make sound, evidence based clinical decisions regarding the requested cases (treatments and procedures) for IP/OP and performs retrospective clinical reviews utilizing criteria set forth by the client and Medicare (CMS-Centers for Medicare and Medicaid Services) and perform outbound calls to providers.

Responsibilities

Performs clinical review of cases received from the specialist team or other departments within CCR, determines if additional clinical information if required, makes a clinical decision to approve or deny a case based on plan coverage, criteria and / or guidelines or pend / refer it to the Regional Medical Directors for further review for medical necessity, and coordinates a peer to peer (doctor to doctor case discussion) review as applicable.

Qualifications

Bachelor Degree in relevant field with 6- 8 years of relevant experience

Job Details

Role Level:	Executive-Level	Work Type:	Full-Time
Country:	India	City:	Pune ,Maharashtra
Company Website:	http://www.exlservice.com	Job Function:	General Management
Company Industry/ Sector:	Business Consulting and Services

What We Offer

About the Company

Searching, interviewing and hiring are all part of the professional life. The TALENTMATE Portal idea is to fill and help professionals doing one of them by bringing together the requisites under One Roof. Whether you're hunting for your Next Job Opportunity or Looking for Potential Employers, we're here to lend you a Helping Hand.

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