2 Claims Investigation Jobs

JOB DESCRIPTION HOSPITAL RELATIONS MANAGER Job Title: Chief Manager Department: Hospital Relations Location: Pune, Pimpri, Nagpur, Nashik, Kolhapur, Solapur, Aurangabad Job Type: Full-Time Job Summary: The Hospital Relations Manager will be responsible for managing and optimizing the relationship between the organization and hospital partners. This role involves overseeing pricing strategies, negotiating claims, resolving pending issues, and ensuring smooth coordination with internal stakeholders. The position also requires meticulous documentation related to training, meetings with internal and external stakeholders and updates to facilitate effective communication and decision-making. Key Responsibilities: 1. Hospital Visit Management: Conduct regular visits to hospital partners to review and address pricing structures, contract terms, and service quality. Analyze and assess hospital billing and pricing strategies to ensure alignment with organizational objectives. 2. Claims Negotiation: Lead negotiations with hospital partners regarding claims and reimbursement issues to ensure favorable outcomes for the organization. Work closely with the internal claims team to resolve discrepancies and expedite claim resolutions. 4. Pending Issues and Concerns: Identify, track, and resolve pending issues and concerns related to hospital partnerships, including billing disputes, service quality, and contractual obligations. Act as a liaison between the hospital and internal teams to address and mitigate concerns promptly. 5. Coordination with Internal Stakeholders: Collaborate with internal departments to ensure alignment on hospital-related activities and strategies. Facilitate effective communication and coordination between internal teams to address issues and implement solutions. 6. Documentation and Reporting: Prepare and maintain comprehensive documentation of hospital visits, pricing agreements, claims negotiations, and issue resolutions. Document and update sales meetings, including key takeaways, action items, and progress reports. 7. Sales Meeting Coordination: Organize and lead sales meetings to discuss hospital partnerships. Provide regular updates and reports to sales teams and management on hospital-related activities and performance. Qualifications: Bachelors degree in Business Administration, Healthcare Management, Doctor Minimum of 10 years of experience in hospital relations,Provider Management, healthcare finance, or a similar role. Strong negotiation skills with a proven track record of successful claims resolution. Excellent communication and interpersonal skills to effectively interact with hospital partners and internal teams. Proficiency in Excel, PowerPoint, MS Word. Ability to handle complex issues and provide strategic solutions in a fast-paced environment. Preferred Skills: Experience with hospital billing systems and healthcare reimbursement processes. Knowledge of insurance industry regulations and compliance requirements. Working Conditions: Outdoor visits to hospitals. Flexibility to work outside regular office hours as needed for urgent issues or meetings.

Introduction A career in IBM Consulting embraces long-term relationships and close collaboration with clients across the globe. In this role, you will work for IBM BPO, part of Consulting that, accelerates digital transformation using agile methodologies, process mining, and AI-powered workflows. Youll work with visionaries across multiple industries to improve the hybrid cloud and AI journey for the most innovative and valuable companies in the world. Your ability to accelerate impact and make meaningful change for your clients is enabled by our strategic partner ecosystem and our robust technology platforms across the IBM portfolio, including IBM Software and Red Hat. Curiosity and a constant quest for knowledge serve as the foundation to success in IBM Consulting. In your role, youll be supported by mentors and coaches who will encourage you to challenge the norm, investigate ideas outside of your role, and come up with creative solutions resulting in groundbreaking impact for a wide network of clients. Our culture of evolution and empathy centers on long-term career growth and learning opportunities in an environment that embraces your unique skills and experience. About Business Unit: Spartan Technology Services and Solutions Private Limited, a subsidiary of IBM, operates globally across 170 countries. Its a crucial part of IBM Business Process Operations, offering end-to-end services for policy renewal and query resolution in the insurance industry, with a strong commitment to data security and quality. Your role and responsibilities As a Process Associate - Insurance (Claims), you will be involved in the Processing of Life and Annuity Insurance, Claims processing. You should be flexible to work in shifts. Your primary responsibilities include: Handling claims investigation, processing, and payments Claims document validation, calculating benefit amount, and releasing same to the beneficiary Meet productivity and quality targets on a daily, weekly, and monthly basis Required education Bachelors Degree Preferred education Masters Degree Required technical and professional expertise Graduate (except B.Tech/Technical Graduation/Law) with a minimum of 1.5 years of experience in Life/Annuities products in Claims Good Communication skills - English (both written & verbal) Proactive and high analytical skills should foresee issues and suggest solutions, with impactful data Basic Computer knowledge along with typing speed of 35 words/minute Preferred technical and professional experience Proficient in MS Office applications Self-directed and ambitious achiever Meeting targets effectively Demonstrated ability to analyze complex data, complemented by strong interpersonal and organizational skills