310 Claim Settlement Jobs

Process and review Life insurance claims, ensuring adherence to company policies and guidelines. Verify claim documentation, including Death certificate , Employment details, medical records to rule out cause of death and co-morbidities, PMR, FIR , and other supporting documents. Examine insurance applications and documents to ensure accuracy. Communicate with claimants to obtain necessary information and explain the claim process. Assess the validity and coverage of claims, determining eligibility for reimbursement or settlement. Collaborate with claimants, insurance agents, and medical professionals to gather necessary information and resolve any claim-related queries or issues. Keep claim files organized, documenting all actions and decisions. Decision-Making: Determine claim payouts by verifying coverage and assessing the insurance policy. Collaborate with internal teams, such as underwriters and legal departments, to evaluate complex claims and ensure compliance with regulatory requirements. Keep up-to-date with insurance industry trends, policies, and regulations related to Life insurance claims. Requirements: DOCTORS Preferable. Degree in BMS/BAHMS/MBBS, etc (medical background) Previous experience in Life claims processing or a similar role within the insurance industry. In-depth knowledge of insurance principles, policies, and procedures, specifically related to Life Term insurance. Strong understanding of Life claim processing and settlement methodologies. Excellent analytical and problem-solving skills, with the ability to make sound decisions regarding claim eligibility and coverage. Attention to detail and accuracy in reviewing and processing claim documentation. Exceptional communication skills to interact effectively with claimants, insurance agents, and internal stakeholders. Proficient in using relevant software applications and tools for claim processing and record-keeping. Ability to work independently, manage multiple tasks, and prioritize workload effectively. Familiarity with regulatory guidelines and compliance requirements related to Life insurance claims. In addition to the above requirements, as an executive-level profile, the ideal candidate should also possess: Leadership skills to oversee and mentor a team of claims processors. Proven experience in managing and optimizing claims processing workflows. Strong problem-solving and decision-making abilities, particularly in complex or high-value claim scenarios. Excellent interpersonal skills to collaborate with senior management, stakeholders, and external partners. Demonstrated ability to analyse data, generate reports, and present findings to senior executives. Knowledge of strategic planning and business development concepts within the insurance industry.

Job Title: TPA Manager Location: Miri Piri Institute of Medical Science & Research, Shahabad Markanda, Kurukshetra (Haryana) Hospital Strength: 420+ bedded upcoming super-specialty hospital & upcoming medical college (100 MBBS seats) Position Overview We are seeking an experienced and detail-oriented TPA Manager to lead and manage all Third-Party Administrator (TPA), insurance, CGHS, ECHS, and Ayushman cases. The role involves overseeing pre-authorization, billing, claims settlement, and ensuring smooth coordination between patients, TPAs, and hospital departments while maintaining compliance and accuracy. Key Responsibilities Handle end-to-end TPA, Insurance, Ayushman, CGHS, and ECHS cases. Coordinate with patients, TPA representatives, and consultants for pre-authorization approvals. Monitor real-time admission intimation, approval status, and treatment cost estimates. Ensure accurate preparation and timely submission of claims to TPAs/Insurance companies. Follow up on pending claims, resolve queries, and minimize claim rejections. Maintain updated records of approvals, discharges, and settlement status. Collaborate with billing, finance, and medical teams for seamless case management. Train and guide TPA executives in documentation and claim processing. Ensure compliance with NABH requirements, audit standards, and hospital policies. Generate MIS reports on approvals, rejections, pending claims, and revenue flow. Eligibility Qualification: Graduate/Postgraduate in Healthcare Administration, Finance, or related field. Experience: Minimum 5 years of experience in TPA/Insurance management in a multi-specialty hospital. Skills: Strong knowledge of insurance/TPA processes, claim settlement, negotiation, MIS reporting, patient handling, and excellent communication. Why Join Us? Be part of an upcoming medical college with 100 MBBS seats backed by the credibility of SGPC . Opportunity to work in a 420+ bedded super-specialty hospital with advanced facilities. Supportive work culture, timely salary , and ethical governance. Significant scope to grow in hospital operations and insurance management. Contact for Queries: +91 9650779097 Email: miripirihr@gmail.com

Role & responsibilities We are looking for an accomplished Doctors with significant ICU experience and a strong ability to manage both clinical and non-clinical responsibilities. The ideal candidate will excel in patient care, clinical documentation, and possess in-depth knowledge of medical documentation essential for insurance claims processing. Key Responsibilities: Patient Documentation: Manage patient medical history and progress notes with precision. Claims Processing: Handle preauthorization and reimbursement claims, including validation and processing. Clinical Records: Maintain accurate clinical documentation in compliance with healthcare standards. Collaboration: Work closely with consultant surgeons and physicians on treatment management. Diagnostic Insights: Provide valuable insights on diagnostic tests, laboratory results, and imaging to support treatment decisions. Real-Time Support: Collaborate with bedside teams to offer real-time critical care expertise. Regulatory Updates: Stay informed on the latest medical guidelines, insurance policies, and healthcare regulations. TPA experience is a plus Preferred candidate profile

Managing Deduction claims and Invoice claims processing in SAP TPM Assist with promotional event enrolments / claim approvals. Ensure all customer contract legends are current to provide Trade Promotion Analyst guidance. Maintain a strong control environment with accurate trade accruals, contract approvals and verification. Manage exception through verbal and written interactions with Sales and Sales Finance. Responsibilities Managing Deduction claims and Invoice claims processing in SAP TPM Assist with promotional event enrolments / claim approvals. Ensure all customer contract legends are current to provide Trade Promotion Analyst guidance. Maintain a strong control environment with accurate trade accruals, contract approvals and verification. Manage exception through verbal and written interactions with Sales and Sales Finance. Qualifications 1-4 Years of Financial work experience Excellent analytical skills and the ability to translate analytical findings into actionable solutions and processes. Strong communication skills to manage information gathering requests. Results oriented with the ability to complete assignments in a timely manner. Proficient in Microsoft Excel with the ability to quickly learn SAP CRM/BW software applications. 1-4 Years of Financial work experience Excellent analytical skills and the ability to translate analytical findings into actionable solutions and processes. Strong communication skills to manage information gathering requests. Results oriented with the ability to complete assignments in a timely manner. Proficient in Microsoft Excel with the ability to quickly learn SAP CRM/BW software applications. Managing Deduction claims and Invoice claims processing in SAP TPM Assist with promotional event enrolments / claim approvals. Ensure all customer contract legends are current to provide Trade Promotion Analyst guidance. Maintain a strong control environment with accurate trade accruals, contract approvals and verification. Manage exception through verbal and written interactions with Sales and Sales Finance.

Hiring for Wns Please find below the JD and hiring inputs for Payment Posting Post all insurance ACH , manual checks and credit card payments to accounts in the practice management systems in a timely and accurate manner. Record and balance batch totals daily. Ensure payments, allowances, adjustments, denials and rejections are researched and posted with a high degree of accuracy. Research and clear unapplied payments and recoupment payments from payor. Identify payor fees not being paid at the allowed or contracted amount and communicate these findings to the Supervisor or Manager. Access payer websites to obtain Explanation of Benefits. Complete office requests for locating payments and adjustment needs. Perform all other duties and projects assigned. Qualification : Graduate in any stream. Experience : 2-3 years of experience in payment posting.

Claims Management: Process, submit, and follow up on insurance claims, resolving discrepancies and denials with insurance providers. Patient Assistance: Educate patients on their insurance coverage and benefits and assist them with understanding their bills and statements. Liaison with Insurers: Serve as a point of contact between the hospital and insurance companies, ensuring proper communication and adherence to policies. Data and Reporting: Maintain accurate patient insurance information in the billing system and prepare reports on billing and insurance activities. Compliance: Ensure adherence to hospital policies and insurance regulations and guidelines Skills: Excellent communication and interpersonal skills. Strong organizational and attention-to-detail skills. Proficiency in insurance billing, coding, and claims processing. Knowledge of healthcare systems, insurance regulations, and compliance. Problem-solving and conflict resolution skills. Computer proficiency and the ability to work with data entry and reporting tools.

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or deny the claims as per the terms and conditions within the TAT. Handle escalations and responding to mails accordingly. Work from Office only 4th floor, AARPEE Chambers, Off Andheri-Kurla Road Industrail Estate Marol, Andheri East, , Marol Cooperative Next To Times Square, Shagbaug, Gamdevi, Marol, Mumbai, Maharashtra 400059 Interested candidates can share their resumes to abhilasha.dutta@mediassist.in Whatsapp : 8050700698.

ROLE & RESPONSIBILITIES Preauthorization claim processing Manage the Turnaround time. Quality adjudication with Errorless Rotational basis shift (8 AM to 10:30 PM) WFO only QUALIFICATION & EXPERIENCE: BHMS/BAMS/BUMS/BDS/BPT 1-2 years Experience Knowledge of insurance field Strong medical knowledge Fresher also can apply KEY COMPETENCIES & SKILLS REQUIRED MS office Communication Medical knowledge/disease knowledge Note- Interested candidates can share their resume at vishali.massey@nivabupa.com

Role Overview: You will be responsible for overseeing insurance-related matters, managing claim processes, and ensuring effective coordination with insurers and stakeholders. This role demands high levels of professionalism, analytical ability, and attention to compliance. Additionally, you should be flexible to undertake occasional travel outside Surat for claim inspections and related engagements. Key Responsibilities: - Administer and oversee insurance policies, including renewals, endorsements, and compliance requirements. - Manage the complete claim settlement cycle, from initiation and documentation to final closure. - Coordinate with insurance companies, surveyors, auditors, and internal departments to expedite claim resolution. - Conduct verification of claim documents, prepare financial and compliance reports, and present findings to management. - Maintain accurate and up-to-date records of insurance policies, claims, and settlements. - Ensure adherence to statutory, regulatory, and organizational compliance standards. - Assist the finance team with reconciliations and insurance-related accounting. - Undertake occasional travel outside Surat for claim assessments, negotiations, or inspections as required. Qualification Required: - Semi-Qualified Chartered Accountant (CA Inter cleared). - Must not be pursuing CA qualification further. - 1-3 years of professional experience in insurance, claim settlement, auditing, or finance is preferred. - Strong analytical, negotiation, and documentation skills. - Proficiency in financial compliance and reporting standards. - Excellent written and verbal communication abilities. - Self-motivated, detail-oriented, and capable of working independently. - Willingness to travel outside Surat on a need basis.,

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or deny the claims as per the terms and conditions within the TAT. Handle escalations and responding to mails accordingly. Work from Office only 4th floor, AARPEE Chambers, Off Andheri-Kurla Road Industrail Estate Marol, Andheri East, , Marol Cooperative Next To Times Square, Shagbaug, Gamdevi, Marol, Mumbai, Maharashtra 400059 Interested candidates can share their resumes to varsha.kumari@mediassist.in

Job Title: Term Insurance Operations Specialist Experience: 1 - 3 Years in insurance operations Education: Any Graduate Location: Gurugram About the Role: As a Term Insurance Operations Specialist, you will be responsible for ensuring a smooth post-payment customer journey by managing documentation, medical scheduling, and verification processes. You will coordinate with insurers, underwriters, TPAs, and internal stakeholders to drive timely case issuance while meeting monthly issuance targets with minimal TAT and high FTR rate. This role demands strong communication, stakeholder management, and process improvement skills, along with a basic understanding of insurance underwriting and proficiency in Excel. Responsibilities: Take complete ownership of post-payment cases and ensure a smooth customer journey. Connect with customers (via calls & emails) to update them on next steps and pending requirements such as document collection, verification, scheduling medicals, and retention. Coordinate with stakeholders (Insurers, TPA’s, underwriters, business SPOCs, etc.) to ensure timely case issuance. Achieve monthly issuance targets with minimal TAT (Turnaround Time) and high FTR (First Time Right) rate. Work closely with Insurers to improve operational processes for better issuance rates, reduced TAT, and improved FTR. Requirements: Strong written and verbal communication skills. Basic understanding of insurance underwriting and decision-making processes. Ability to handle customers patiently, including difficult conversations. Proven stakeholder management skills to push cases forward. Minimum 1+ year of experience in Insurance operations. Basic computer and Excel skills. About Hireginie: Hireginie is a prominent talent search company specializing in connecting top talent with leading organizations. We are committed to excellence and offer customized recruitment solutions across industries, ensuring a seamless and transparent hiring process. Our mission is to empower both clients and candidates by matching the right talent with the right opportunities, fostering growth and success for all.

Prepare and process bills of turnkey contractors and vendors. Coordinate with site engineers and accounts team. Maintain records and support billing documentation. Ensure timely submission of bills and accuracy in entries.

Position: Medical Officer (Doctor) - TPA for Insurance and Risk Analysis Location: Gurgaon Job Type: Full-time About Policybazaar For Business Policybazaar, the flagship platform of PB Fintech Ltd., is Indias largest online insurance marketplace, acclaimed by Frost & Sullivan. Established in 2008, Policybazaar has revolutionized insurance with unmatched awareness, choice, and transparency. Introducing Policybazaar for Business, a dedicated service designed to meet the unique insurance needs of enterprises. Launched in 2021, it offers a robust portfolio of 15+ business insurance products tailored to diverse sectors, scales, and risk profiles. Policybazaar for Business aims to fortify Indias financial ecosystem by ensuring every business is insured and worry-free. With a track record of serving over 25,000 corporates, Policybazaar for Business excels in delivering precise risk analysis and bespoke solutions. From chemicals and infrastructure to IT, renewable energy, hospitality, and logistics, Policybazaar for Business is your trusted partner in safeguarding your enterprise& future. Job Overview: We are seeking a qualified and experienced Medical Officer (Doctor) to join our team at Policybazaar for Business. This role involves using medical expertise to assist in evaluating insurance claims, conducting risk analysis, and ensuring that the medical aspects of claims are handled in accordance with industry standards and regulations. The ideal candidate will have a strong background in healthcare and an understanding of insurance policies and risk management in the medical field. Key Responsibilities: Claims Review and Evaluation: Review medical claims submitted by policyholders to ensure accuracy and compliance with insurance policies. Analyze the medical documentation provided by hospitals, clinics, and other healthcare providers to determine the legitimacy of claims. Assess the medical necessity of procedures, treatments, and hospital admissions as per the insurance policy guidelines. Provide second opinion or consultation on disputed claims or complex medical cases. Risk Assessment and Management: Perform risk assessments based on medical data and historical trends to help evaluate and manage potential risks for both policyholders and insurers. Analyze patient medical history and treatment plans to identify high-risk cases and potential fraud. Collaborate with the underwriting team to provide insights into risk factors and potential areas of concern in the policyholder pool. Medical Advisory Services: Provide expert advice and medical guidance to the TPA team, insurance providers, and policyholders regarding medical treatment, diagnoses, and claims. Act as a liaison between healthcare providers and the insurance company to ensure a seamless claims process and accurate policyholder information. Policy Development and Compliance: Assist in the development of health insurance policy guidelines to ensure they are medically sound and compliant with regulatory standards. Stay up-to-date with the latest medical trends, technologies, and regulations to ensure policies reflect current medical practices. Ensure compliance with healthcare laws and insurance industry regulations during the claims processing and risk evaluation stages. Medical Audits and Reports: Conduct medical audits to ensure the accuracy of claims and prevent fraud. Prepare detailed reports regarding the medical aspects of claims, risk assessments, and policy compliance for senior management and insurers. Collaboration with Medical Providers: Communicate with healthcare providers, hospitals, and clinics to clarify medical information and ensure proper documentation is available for claims processing. Collaborate with medical professionals in cases of complex treatments or potential discrepancies between claimed and provided medical services. Educational Qualifications: Medical degree (MBBS, MD, or equivalent) from a recognized institution. Relevant specialization (if any) is a plus (e.g., General Medicine, Surgery, etc.). Experience: Minimum of 5 years of experience in the healthcare industry, ideally in a clinical or insurance-related environment. Experience with medical claims evaluation, health insurance, or risk management is highly desirable. Familiarity with healthcare laws, regulations, and insurance policies is a plus.

Dear Candidates, Greetings from HealthIndia Insurance TPA Service Pvt. Ltd. Company Profile - We are provide highest level of quality health care by creating a platform which is entirely dedicated to service excellence, patient care and health education to the members. For more details kindly go through company website: https://www.healthindiatpa.com Currently we have an opening in Customer Relationship Management Department for Executive Role . Location: HEALTHINDIA INSURANCE TPA SERVICES PVT LTD. PLOT NO 312 ,2ND FLOOR, PHASE 2, UDYOG VIHAR-OPPOSITE TO ICICI BANK UDYOG VIHAR, GURUGRAM, HARYANA -122016 Roles & Responsibilities: Handling Major Corporate Group. Solving Customer/Broker's queries related to claims and other issues. Following up with Insurance Company for endorsement and getting the same updated in system. Guiding customers to apply for claims and with policy Terms & Conditions. Register claims in system. Grievance resolution by taking follow from the operation team. Tracking up the claims file for & updating to the corporate client till the claim get settled. Following up for cheque dispatch details and NEFT details with backend and banks. Maintaining day to day activities on the worksheet. Preparing & Sending Monthly MIS to Corporate. Good Communication skills (written & verbal) and attitude is mandatory. Salary no match for the right candidate. If Interested, Kindly share updated resume on email id - roshni.rajbhar@healthindiatpa.com or contact us at - 8976760612 Roshni Rajbhar, HR Team, roshni.rajbhar@healthindiatpa.com 8976760612

As a Sales Manager at our company, your role involves promoting and selling our products in a competitive environment to achieve Company and Individual targets. Your key responsibilities will include: - Developing an overall sales strategy for the existing product group, specifically furniture components - Managing OEM and Dealer Business relationships - Building and maintaining relationships with Architects, Consultants, Engineers, Designers, and customers - Conducting detailed technical presentations, preparing proposals, cost estimations, and quotations - Organizing and executing product presentations at trade shows and events - Implementing monthly sales tracking systems like sales reports - Regularly visiting customers to understand their business, buying patterns, and technical requirements - Servicing existing customers and exploring new market development opportunities - Assisting in effective Credit Management using marketing tools - Ensuring timely collection of Sales Tax statutory forms from Customers - Leading a team of sales executives or Area Sales Managers - Handling and settling claims - Keeping abreast of industry, market, and legislative drivers to maintain processes - Maintaining profiles of customers and their competitors" strengths, weaknesses, opportunities, and threats - Collaborating with Channel partners, OEMs, and Influencers to drive sales - Implementing marketing strategies in the area - Increasing primary and secondary sales by working closely with Dealers and distributors - Establishing good relations with OEMs and influencers by regular meetings Qualifications: - Any Graduate, MBA preferred Experience: - 5 to 10 years in a similar Industry (Hardware | Laminate | Boards | Adhesive) Please note that this is a full-time position.,

Job Description Position: Auto Claim Adjuster Job Title: Auto Claims Adjuster Department: Claims Reports to: Claims Manager Location: Bangalore Employment Type: Full-time Roles & Responsibilities : Dealing with Insurance Companies for Auto claims only Dealing with Location Managers for paper formalities Maintaining In-House location, Insurance companies etc. Coordinating with parent company representatives Skills & Qualifications : 1 - 3 years SOLID experience with insurance company Claims Dept or Brokerage dealing with AUTO claims / Auto Insurance only Knowledge of LOCAL Auto insurance regulatory laws Good Communication & Negotiation Skills (writing and speaking) Time flexibility requirement, and should be self-motivated Hands-on capabilities Room to Grow Bachelors degree in a related field or equivalent work experience Compensation: Fixed Salary + Incentive - 2 Rounds of interviews and joining would be immediately after the 2nd round of interviews. - Background check and verification is required. Shift - Night shift ( Canadian Timings ) 6 Days working - Sunday Off Location - Serene Building No.106, 4th Floor, 4th C Cross Rd, 5th block, Koramangala Industrial Layout, S.G. Palya, Bengaluru, Karnataka 560095 If Interested directly visit to our office location for F2F Interview Notes: If interested in auto claims then only Please apply - US/Canada process Open to freshers with strong English communication skills. Notes: If interested in auto claims then only Please apply If You have Auto claims experience, Apply Please Can attach resume to Shankar@caledontechnologies.com

ONLY for VOICE- 50k joining bonus US Process / UK process WFO Salary - upto to 20- 51 k in-hand ( HSC or Grad with min 2 - 3+ years of exp into BPO) 5 days working 2 rotational off excellent communication skills home pickup home drop

Role & Responsibilities Handling TPA related all process from billing to co-ordinate with TPA companies. Responsible for counseling patient's family & pre-Auth process. Maintaining & uploading patient's files on the portal. Couriering the hard copy of patient's medical file to the Insurance companies. Responsible for all co-ordination activities from patient's admission to discharge. Handling billing Department, Implants bill updating & reconciliation. Daily co-ordination with the patient and Hospital staff. Outstanding follow-up with TPA. To obtain and review referrals and authorizations for treatments. Must be aware of norms of the insurance sector. Daily follow up with Insurance companies to pass or clear the Health Insurance claims. Qualifications Bachelor's degree. Previous experience in TPA management or Banking. Good interpersonal and communication skills. Simran Sandhu 7696661783

To contact the insured for Underwriting referred proposals to procure the complete medical history using Audio and/or Video tools. To Follow up with customer for past medical records and/or relevant health documents Maintain end to end TAT / SLAs. Required Candidate profile Location – Bangalore Candidate must know to speak excellent English. CTC – Upto 3.5 LPA

Salary: Up to 23,000 CTC + Incentives (5,000 – 7,000) Qualification: Minimum 12th Pass with Experience / Graduate fresher Shift Timing: 5:30 PM – 2:30 AM (Fixed Shift) Working Days: 5 Days/Week (Saturday & Sunday Fixed Off) Facilities: Cab + meal

Role & responsibilities: Outline the day-to-day responsibilities for this role. Preferred candidate profile: Specify required role expertise, previous job experience, or relevant certifications.

Job Description: 1. Conduct insurance claim & valuation surveys of industrial, commercial & residential properties, prepare reports, handle correspondence, and assess losses as per policy coverage. Education: B.Tech (Civil/Mech/Elec), Freshers. Health insurance Provident fund

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or deny the claims as per the terms and conditions within the TAT. Handle escalations and responding to mails accordingly. Work from Office only 4th floor, AARPEE Chambers, Off Andheri-Kurla Road Industrail Estate Marol, Andheri East, , Marol Cooperative Next To Times Square, Shagbaug, Gamdevi, Marol, Mumbai, Maharashtra 400059 Interested candidates can share their resumes to ronojoy.bagchi@mediassist.in

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or deny the claims as per the terms and conditions within the TAT. Handle escalations and responding to mails accordingly. Work from Office only 4th floor, AARPEE Chambers, Off Andheri-Kurla Road Industrail Estate Marol, Andheri East, , Marol Cooperative Next To Times Square, Shagbaug, Gamdevi, Marol, Mumbai, Maharashtra 400059 Interested candidates can share their resumes to abhilasha.dutta@mediassist.in

Walkin : Mon to Sat between 11am to 3pm - Siruseri Unit Job Title: Insurance Co-ordinator Role & responsibilities: List out the total Number Of credit patients (All Insurance). To send the Pre- Authorization form to the concern insurance company. Explain the Admission & Discharge procedure to the patient & attenders also. All data's and activities should be computerized. Watch the approval status and query reply to be update shortly. To Proper communication about the patient Admission, Approval, Enhancement procedure, Discharge, Payment, and cancellation process. The most common job duties for a health unit coordinator are clerical tasks like answering phones and processing paperwork, including discharge, transfer, and admittance forms. Health unit coordinators also often act as a liaison between patients, nurses, doctors, and different departments within the hospital or care facility. Other tasks can include scheduling procedures like tests and x-rays, transcribing doctors' orders, and ordering medical and office supplies. Health unit coordinators are a part of a broader medical team, and are expected to keep pace with the potentially hurried and stressful environments in which they work. Heath care coordinators work closely with patients on a one-on-one basis. They provide guidance, support, and advice to patients dealing with complex medical issues. These professionals can help their clients navigate through a medical care scenario that may involve a variety of different doctors and treatment methods. Duties can include scheduling appointments, assisting with major decisions, helping patients understand complex medical information, evaluating care quality, and working with other health care professionals to ensure that the correct path is being taken. To Properly Intimate the consultants about credit limits. To make sure the Surgery details, Summary follow ups with consultants. To maintain the good rapport with consultants. Follow ups for consultant Payments. Reporting to Head of the department. Job Title: Executive - Credit Recovery Role & responsibilities: Marking Despatch details & updating claim details in KMH Internals Combinedly doing OS reconciliations as required with TPA/Corporates Sending out monthly OS statements / letters to TPA. / Corporates as may be agreed from timeline Marking Despatch details & updating claim details in KMH Internals Delivering Doctor's cheque with in time line Receiving acknowledgements for cheques submission from doctor & closing the entry in KMH DERN Collecting our Hospital other unit bills & submitting at agreed corporates. Follow up with TPA/Corporates for refund of collectible disallowance Regular follow up for renewing for MOU with TPA/Corporates Submitting Hospital Revised Tariff list to TPA / Insurance Reporting to Senior Officer - Credit Recovery Preferred candidate profile: Any Degree Holder (UG/PG Arts & Science) A minimum of 2 to 10 years of experience in Insurance. Working knowledge of Insurance standards Proficient in Microsoft Office. Strong attention to details. Perks and benefits: ESI, EPF Gratuity Contact person: Naveenkumar - HR - omrhr@drkmh.com