414 Claims Management Jobs - Page 6

Role & responsibilities To be able to process P & A claims as a Claims Manager Preferred candidate profile Any Graduate with experience of minimum 1year with P&A Claims experience in Health

Role & responsibilities Shift timings (01:30 PM - 10 PM ) Hybrid Mode- Work from office. Looking for Immediate joiner. What will you do? Review complex claims and estimates for completeness and follow processes for incomplete information on claims Assess and adjudicate complex claims and estimates Assessing includes studying dental information and plan provisions, researching, documenting results and communicating verbally and or in writing with the client (member/sponsor) to obtain additional details in order to make an informed decision Meet production and quality standards set for individuals, teams and department (timeliness, quality and service) Handle external and internal inquiries via written correspondence, e-mails and telephone as required Participate in departmental projects as required. Work in conjunction with the Dental Consultant on contentious cases, and with other departments/offices within the company in order to meet customer expectations Key Qualifications and experience: Diploma in Dental Hygiene (CEGEP/College or University Experience working in a dental clinic Strong knowledge of Group Insurance - Dental claims Customer service oriented Excellent communication skills both verbal and written Excellent problem solving skills Self motivated Team Oriented Ability to work in a changing environment Decision-maker Open to retroaction and giving feedback Bilingualism (French and English, verbal and written) nice to have Your scope of work / key responsibilities: Review complex claims and estimates for completeness and follow processes for incomplete information on claims Assess and adjudicate complex claims and estimates Assessing includes studying dental information and plan provisions, researching, documenting results and communicating verbally and or in writing with the client (member/sponsor) to obtain additional details in order to make an informed decision Meet production and quality standards set for individuals, teams and department (timeliness, quality and service) Handle external and internal inquiries via written correspondence, e-mails and telephone as required Interested candidate can share their resumes at V.vaibhav@sunlife.com Preferred candidate profile

Role & responsibilities Seamless processing of Insurance Claims till the closure & recovery of the cost incurred in repair. Co-ordination with third party service providers with respect to timely collection of claim documents, verification of the documents and submission to the insurer for settlement. Ensuring 100% documents are checked and verified to achieve FTR > 98%. Ensuring compliance with all applicable processes, policies & standards and adherence to timelines. Analysis of claims data to identify trends and potential areas for improvements in the claims handling process Propose and assist in the implementation of improvements in the claims handling process to enhance efficiency & accuracy and also help in minimizing losses. Implementation of automation to enhance efficiency and reduce turn around time. Data management & publishing of key dashboards the internal/external stakeholders involved. Maintain and update of various data sets required for the business through various channels Ability to handle team and constantly reviewing the team performance. Ability to manage team by setting clear goals, providing regular feedback and coaching, fostering open communication and collaboration, recognizing and leveraging individual strengths, addressing conflicts constructively Preferred candidate profile 6+ years of experience in processing insurance claims Experience with Affinity product claims is highly preferred

Analyst Claims- Review and process property insurance claims, including analyzing policies, assessing damage, and determining coverage and settlements. Work with insurance adjusters, clients, and third-Frty vendors to gather necessary information and documentation for claims processing. Collation of data and information of claims for reporting purposes Investigate and evaluate claims to ensure accuracy and completeness. Prepare and present reports and recommendations to management regarding claims status, trends, and outcomes. Involvement in subrogation requests and required follow-ups. Communicate with clients and stakeholders regarding claims status and resolution. Provide support to other departments and teams as needed. What You Bring To The Role Bachelor's degree in business, finance, or related field. At least 3 years of experience in property insurance claims analysis. Strong analytical and problem-solving skills. Excellent verbal and written communication skills. Detail-oriented with the ability to manage multiple tasks simultaneously. Proficient in Microsoft Office Suite and other relevant software programs. Knowledge of property insurance policies, procedures, and regulations. Other skills: Ability to work independently as well as be a team player. Able to take direction and ask questions. Strong organizational skills. Eye for detail. Resourcefulness. Excellent communication skills Mandatory Skills: Institutional_Finance_Buy_Side_Others. Experience1-3 Years.

POSITION: MEDICAL OFFICER PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Medical Officer Claims PA/RI Approver Reporting to Location Assistant Manager Claims Noida Educational Qualification BHMS, , BAMS Shift Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and 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. • • • Responsibilities 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. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies

POSITION: MEDICAL OFFICER/CONSULTANT PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Chennai Educational Qualification Shift BHMS, , BAMS , BDS, B.Sc Nursing. Rotational Shift (for female employee shift ends at 7:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and 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. • • • Responsibilities 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. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies

HI Warm Greetings from Rivera Manpower Services , WORK LOCATION : Bangalore /Kochi Note : Candidates who are willing to Relocate to Bangalore Can apply. Minimum 3 YEARS Experience in Property and Casualty Insurance /Motor Insurance for US market Can apply Call and book your Interview slots 9986267393 / 7829336034 /9380300644 /7829336202 JD for Senior Process Analyst In this role, Underwriter Assistant assists the Branch Underwriter & plays a vital role in maintaining customer relationship through timely & accurate services. A person will act as a liaison between multiple parties including Branch Underwriter, Policy Servicing Team, Insurance Carriers, and Insurance Brokers, etc. by answering questions & providing detailed information about the accounts/policies via Phone Calls or Emails. To ensure success, Underwriter Assistant should have a friendly and professional attitude, excellent communication skills, and the ability to stay calm under pressure. Should have good understanding of Insurance Domain & minimum experience of 2 years in P&C Insurance. Must have a knowledge of Insurance Life Cycle & worked into minimum 2 different processes. Being an integral part of the production (sales) team in USA, should be ready to work in Night Shift India Time. Work experience in Surplus Lines Insurance or with Managing General Agent (MGA) or with Insurance Broker would be an added advantage. Primary Responsibilities Assist Underwriters in day-to-day duties by: 1. Co-ordinating & collecting information from different stakeholders that requires for underwriting & binding accounts/policies, 2. Binding policies in Carrier as well as Agency Management System along with Invoicing & delivering the same to the clients, 3. Follow-up with clients for bind request, pending information, inspection report recommendation implementation, 4. Ensure all documents/information available in file for policy servicing teams, 5. Handling questions & communication with stakeholders via email & inbound/outbound calls, 6. Updating & ensuring compliance to SL affidavits requirements, 7. Triaging endorsements & cancellations, 8. Facilitating & managing miscellaneous activities that do not require Underwriting decision making Excellent verbal & written communication Graduate with 3+ years of experience in an Insurance domain (P&C /BFSI) Flexible & customer focused Strong problem solving and analytical approach Proactive & accountable Skilled in multi-tasking & prioritizing Exposure to complaints & escalations management Prioritization of work received through different channels Call and book your Interview slots 9986267393 / 7829336034 /7829336202

Skill required: Group Core Benefits- Claims Case Mgmt. Group Disability Insurance Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 year About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com What would you do We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Team prepares a case studyGroup disability coverage is tied to employment. If change or loss of job, the coverage is not portable. The cost of group coverage can also change from year to year. It is a sort of insurance that pays out if a policyholder is unable to work and earn an income due to a disability. What are we looking for Problem-solving skills. Written and verbal communication. Collaboration and interpersonal skills. Ability to meet deadlines. Process-orientation Roles and Responsibilities: Your expected interactions are within your own team and direct supervisor. You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments. The decisions that you make would impact your own work. You will be an individual contributor as a part of a team, with a predetermined, focused scope of work. Please note that this role may require you to work in rotational shifts Qualification Any Graduation

Skill required: Group Core Benefits- Claims Case Mgmt. Group Disability Insurance Designation: Claims Management Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com What would you do We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Team prepares a case studyGroup disability coverage is tied to employment. If change or loss of job, the coverage is not portable. The cost of group coverage can also change from year to year. It is a sort of insurance that pays out if a policyholder is unable to work and earn an income due to a disability. What are we looking for Problem-solving skillsWritten and verbal communicationCollaboration and interpersonal skillsAbility to meet deadlinesProcess-orientation Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your expected interactions are within your own team and direct supervisor You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments The decisions that you make would impact your own work You will be an individual contributor as a part of a team, with a predetermined, focused scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation

Greeting from Medi assist TPA Pvt ltd. Hiring Medical officer for Insurance Claim processing Profile Location- Mumbai -Andheri East. Role - Medical officer Exp : 0-8 years Job description : * Check the medical admissibility of claim by confirming diagnosis and treatment details * Verify the required documents for processing claims and raise an information request in case of an insufficiency * Approve or deny claims as per T&C within TAT Interested candidate can drop there resume in my Mail ID : varsha.kumari@mediassist.in We are looking for fresher or exp candidates BAMS, BHMS, B.sc Nursing, BPT mail id - varsha.kumari@mediassist.in Thanks & Regards Email: varsha.kumari@mediassist.in

Greeting from Medi assist TPA Pvt ltd. Hiring Medical officer for Insurance Claim processing Profile Location- Mumbai -Andheri East. Role - Medical officer Exp : 0-8 years Job description : * Check the medical admissibility of claim by confirming diagnosis and treatment details * Verify the required documents for processing claims and raise an information request in case of an insufficiency * Approve or deny claims as per T&C within TAT Interested candidate can drop there resume in my Mail ID : varsha.kumari@mediassist.in We are looking for fresher or exp candidates BAMS, BHMS, B.sc Nursing, BPT mail id - varsha.kumari@mediassist.in Thanks & Regards Email: varsha.kumari@mediassist.in

Operations role Pune/Hybrid Permanent Job Description. The Role Must have experience in the insurance domain, specifically in Property & Casualty, claims processing, and operations. Create, update, and maintain operational and SOP documents; manage system access for the Claims leadership team and provide accurate data. Able to work effectively at all levels from managing frontline employees to engaging with executives. Demonstrated ability to identify and implement process improvements within an operations environment. Skilled in managing operational inventory to meet defined Service Level Agreements (SLAs). Ensure all activities are accurately documented in the appropriate client systems. Communicate with Global Claims Relationship Managers to support the execution of global claims strategies and ensure ongoing engagement with assigned carriers. Handle and process claims related to Auto Liability, property damage, personal injury, and liability. Investigate claims, verify coverage, and claim details, and ensure accurate and fair claim submission. Collaborate with adjusters, legal teams, and clients to resolve claims efficiently. Review policy details with clients to ensure clarity and compliance. Maintain detailed and accurate records of policies, claims, communications, and related documentation. Requirements Strong verbal and written communication skills. Familiar with claims processing tools, such as FileHandler. Able to communicate effectively with onsite teams and stakeholders. Capable of operating at all organizational levels from managing frontline staff to interacting with executives. Proven ability to identify and implement process improvements in an operations environment. Skilled in managing operational inventory to meet established Service Level Agreements (SLAs). Ensure all activities are accurately documented in the appropriate client systems. Collaborate with Global Claims Relationship Managers to support the execution of global claims strategies and maintain carrier engagement.

Ghrs Training is looking for an Order Management Executive to join our team. If you have a solid background in managing orders and claims, we encourage you to apply for this vital role. Key Responsibilities: Oversee the end-to-end order management process, ensuring accuracy and efficiency from placement to fulfillment. Manage and resolve customer claims, addressing issues promptly and effectively to ensure customer satisfaction. Coordinate with various internal departments (e.g., sales, logistics, finance) to ensure seamless order processing and claims resolution. Maintain accurate records of all orders and claims in the system. Identify and implement process improvements to optimize order management and claims handling workflows. About You: You have a minimum of 2 years of experience in both order management and claims management.

Hiring for Contracts Administration and Claims Manager at Kalpataru Projects International Limited. Mumbai- Santacruz. Summary: Overall min. 15+ years. Interested can share their resume on barnali.dey@kalpataruprojects.com Ideal candidate shall have experience of minimum 15+ years in handling contract administration and claims management of Solar PV Projects. Area of responsibilities : Detailed study of Pre BID documents, raising pre BID queries; to identify and analyze the potential risk. To support Tendering Team about the prospective risk, its impact and risk Mitigation plan to identify risk. To prepare the contract appreciation documents (CAD) and interpretation of various contractual provisions upon award of works to monitor the Contract at Project Sites. To monitor contractual correspondence with Clients / PMC / Engineer; Claims identification, valuation and timely submission, Application for Extension of Time & Impacted Schedule. To monitor the adherence to Contract Conditions and interpretation of clauses. Drafting and proof reading of the correspondences, agreements and other important documents to safeguard the interest of organization. To co-ordinate with sites to regularize monthly correspondence with BU and HO. To compile Monthly MIS of all communication between organization and the client for all respective sites. To prepare claim status MIS on various contractual entitlements in compliance of Quarterly Review Meetings. To generate and maintain the record of Correspondence for future usage and reference. Competencies: Adaptability / Flexibility . Qualification : Graduate Engineer Skills: Excellent communication and interpersonal skill

Job Title : Claims Admin (Sr Process Executive) Qualification : Any Graduate Experience : 1-4 Years Must Have Skills : l Working experience in SAP. Experience in English communication skills both written and verbal. The ability to work within a deadline focused environment. Excellent knowledge of MS word, excel, Work from office Good to Have Skills : NA Roles and Responsibilities : Claims Administration: l Good understanding on claim processing, creating claims/tickets, dealing with suppliers, credit note handling investigation, follow up on credit note, Booking CN, Creation of Manual RFC (request for credit) l Match RFC to credit, categorize of items refund process. Idea on debit note l Good understanding on dealing with damaged products l Provide refund to store n franchise, dealing with supplier, refund process for damaged products fixit tickets idea on credit note Location : Pune CTC Range : 3.5 - 5.5lpa (lakh per annum) Notice period : Immediate - 30 Days Shift Timings : UK Shift Mode of Interview : Virtual Mode of Work : WFO (work from office) Mode of Hire : Permanent Note : NA -- Thanks & Regards, HR Tanishaa Staffing Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432422 WhatsApp: 7899490271 | | Tanishaa.S@blackwhite.in | www.blackwhite.in

Job Title : Claims Admin (Sr Process Executive) Qualification : Any Graduate Experience : 1-4 Years Must Have Skills : l Working experience in SAP. Experience in English communication skills both written and verbal. The ability to work within a deadline focused environment. Excellent knowledge of MS word, excel, Work from office Good to Have Skills : NA Roles and Responsibilities : Claims Administration: l Good understanding on claim processing, creating claims/tickets, dealing with suppliers, credit note handling investigation, follow up on credit note, Booking CN, Creation of Manual RFC (request for credit) l Match RFC to credit, categorize of items refund process. Idea on debit note l Good understanding on dealing with damaged products l Provide refund to store n franchise, dealing with supplier, refund process for damaged products fixit tickets idea on credit note Location : Pune CTC Range : 3.5 - 5.5lpa (lakh per annum) Notice period : Immediate - 30 Days Shift Timings : UK Shift Mode of Interview : Virtual Mode of Work : WFO (work from office) Mode of Hire : Permanent Note : NA -- Thanks & Regards, HR Sneha Staffing Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432406| sneha.v@blackwhite.in | www.blackwhite.in

Job Title : Claims Admin (Sr Process Executive) Qualification : Any Graduate Experience : 1-4 Years Must Have Skills : l Working experience in SAP. Experience in English communication skills both written and verbal. The ability to work within a deadline focused environment. Excellent knowledge of MS word, excel, Work from office Good to Have Skills : NA Roles and Responsibilities : Claims Administration: l Good understanding on claim processing, creating claims/tickets, dealing with suppliers, credit note handling investigation, follow up on credit note, Booking CN, Creation of Manual RFC (request for credit) l Match RFC to credit, categorize of items refund process. Idea on debit note l Good understanding on dealing with damaged products l Provide refund to store n franchise, dealing with supplier, refund process for damaged products fixit tickets idea on credit note Location : Pune CTC Range : 3.5 - 5.5lpa (lakh per annum) Notice period : Immediate - 30 Days Shift Timings : UK Shift Mode of Interview : Virtual Mode of Work : WFO (work from office) Mode of Hire : Permanent Note : NA -- Thanks & Regards, HR Deekshitha Staffing Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432405| deekshitha@blackwhite.in | www.blackwhite.in

Job Title : Claims Admin (Sr Process Executive) Qualification : Any Graduate Experience : 1-4 Years Must Have Skills : l Working experience in SAP. Experience in English communication skills both written and verbal. The ability to work within a deadline focused environment. Excellent knowledge of MS word, excel, Work from office Good to Have Skills : NA Roles and Responsibilities : Claims Administration: l Good understanding on claim processing, creating claims/tickets, dealing with suppliers, credit note handling investigation, follow up on credit note, Booking CN, Creation of Manual RFC (request for credit) l Match RFC to credit, categorize of items refund process. Idea on debit note l Good understanding on dealing with damaged products l Provide refund to store n franchise, dealing with supplier, refund process for damaged products fixit tickets idea on credit note Location : Pune CTC Range : 3.5 - 5.5lpa (lakh per annum) Notice period : Immediate - 30 Days Shift Timings : UK Shift Mode of Interview : Virtual Mode of Work : WFO (work from office) Mode of Hire : Permanent Note : NA Note : NA -- Thanks & Regards, HR Amala Subject Matter Expert Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432406| amala@blackwhite.in | www.blackwhite.in

Job Title : Claims Admin (Sr Process Executive) Qualification : Any Graduate Experience : 1-4 Years Must Have Skills : l Working experience in SAP. Experience in English communication skills both written and verbal. The ability to work within a deadline focused environment. Excellent knowledge of MS word, excel, Work from office Good to Have Skills : NA Roles and Responsibilities : Claims Administration: l Good understanding on claim processing, creating claims/tickets, dealing with suppliers, credit note handling investigation, follow up on credit note, Booking CN, Creation of Manual RFC (request for credit) l Match RFC to credit, categorize of items refund process. Idea on debit note l Good understanding on dealing with damaged products l Provide refund to store n franchise, dealing with supplier, refund process for damaged products fixit tickets idea on credit note Location : Pune CTC Range : 3.5 - 5.5lpa (lakh per annum) Notice period : Immediate - 30 Days Shift Timings : UK Shift Mode of Interview : Virtual Mode of Work : WFO (work from office) Mode of Hire : Permanent Note : NA Note : NA -- Thanks & Regards, HR Sanjana Staffing Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432421| sanjana.b@blackwhite.in | www.blackwhite.in

Job Overview: We are looking for an experienced Claims Manager to handle non-motor insurance claims (such as Fire, Marine, Liability, Engineering, and other commercial policies ) for our SME clients. The ideal candidate should have a strong technical understanding of policy wordings, loss assessment, and claims lifecycle management, with the ability to coordinate effectively with surveyors, insurers, and internal stakeholders. Location : Ahmedabad Key Responsibilities: End-to-End Claims Management for non-motor SME policies including Fire, Marine, Liability, Engineering, etc. Coordinate with Insurers and Surveyors for timely claim registration, survey appointments, and assessment updates. Verify claim documents and assist clients in claim documentation and submission. Ensure timely follow-up and track the status of pending and approved claims. Resolve claim-related queries or disputes raised by the clients or insurers. Liaise with internal teams (Sales, Operations, etc.) to ensure seamless customer experience. Maintain and update MIS for claims on a regular basis. Analyze claim trends, recommend process improvements, and reduce TAT. Ensure compliance with IRDAI regulations and company protocols. Interested candidates please share your resume on disha.doshi@probusinsurance.com

Manager-Segment Incharge The role is responsible for all tasks related to Processing and Settlement of claims, Monitoring TPA performance for the assigned business. The role includes managing the assigned specialized business handling of any one or more of the following activities: Settlement of Claims, Monitoring TPA performance based on defined KPI, System, Development, UAT, Portfolio Analysis, MIS/Compliance. If this is you, we are looking for you! Key Responsibilities Managing end-to-end claims. Requisitioning detailed information on all reported and settled Claims and monitoring performance of TPAs, evaluating performance of all TPA based on parameters of SLA with Regular Review of defined KPIs. Monitoring and performance evaluation of TPA including timely review of TAT & quality for various process followed in TPAs, daily TAT monitoring, escalation & expectations management for specialized business handling of retail portfolio. Maintaining and updating TPA records on daily basis which help us to know the performance of retail policies and portfolio. Conducting QC of reports and data of TPA shared with us on regular intervals to analysis the data on all benefits as per retail policies. Supporting Actions IT Systems Development System development for uploading and extracting TPA claims and generating reports from the same. Cost containment without losing on customer experience, actionable of feedbacks on claims experience. Educational Qualification: - Preferably MBBS, BHMS, BAMS Doctor Minimum 7-9 years in handling similar role Experience in handling provider management (Hospitals and other vendors) is mandatary. Its a urgent opening please share your resume at aparna@aceconsultants.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 Address: 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 CV to dona.antony@mediassist.in or WhatsApp to 9632777628

Generate leads by various channels, understand clients insurance needs, provide tailored recommendations, Present quotes, educate potential clients about coverage options & help them make decisions, Maintain relationships to ensure satisfaction. Required Candidate profile Meet monthly & annual sales quotas while providing exceptional service to customer Stay tuned on industry trends, ensure all sales with federal & regulation, maintain proper licensing & documentation.

Process: Insurance BPO Designation: Executive & Sr. Executive Job Responsibilities: Efficiently handle and process insurance claims, ensuring accurate documentation, timely initiation, and resolution of claims such as First Notice of Loss (FNOL) and First Report of Injury (FROI). Collaborate with clients, claimants, and internal/external teams to gather necessary information, evaluate claims for coverage and liability, and determine appropriate payment amounts. Maintain detailed and accurate records of claims transactions, ensuring compliance with industry regulations and company policies while safeguarding sensitive client information. Identify potential fraud or discrepancies in claims, escalating issues for further investigation, and resolving claim-related concerns professionally to provide exceptional customer service. Support continuous process improvement initiatives to enhance the efficiency and effectiveness of claims management workflows. Criteria : 1 to 2 years of experience in P&C or Specialty Insurance BPO. Exposure to FNOL and FROI processes. Experience in claim management and payment processing. Willingness to work in US shifts. Week Off: 5 days working Transport: One-way transport provided for candidates within transport boundary Location - LOMA IT PARK, GHANSOLI If Interested share your resume on JuiliD@hexaware.com or 8657971384

Qualification: BDS/ BHMS + MHA Key Responsibilities: * Experience in TPA, Insurance Company, UTI TSL , Hospital Sector * Understanding of the product and provide training and product demo to new and existing clients * Team management/ handing team of Medical officers / quality analysts * Handling operations of the accounts * Meeting and understanding of the customer requirements, plan implementation * Travel to the customer's site as and when required for training and implementing * Ensure service levels are maintained at hospitals * Establish objectives and operational criteria for accounts managed. * Understand the requirements of Clients regularly and implement the process at hospitals. * Motivating / retaining the team members. * Develop and implement organizational policies and procedures for the facility of customers. * Gathering and analyzing data (learning) and using it to plan and implement. * Sitting on Team Meetings and representing the views of clients * Regular Analysis for effective usage of the platform * Planning and implementing strategic changes to improve service delivery. * Extrapolating data for quality assurance and monitoring purposes. * Regular visit to hospitals to review and streamline the process, document and share MOMs * Other activities as assigned by your reporting manager. Flexible in Travelling, Good Communication skills Team Handling, Committed, Accountability and Responsibility.