Role & responsibilities To give Claims & Cashless/preauthorization, and scrutiny Medical Reimbursement Claims, and to Process Claims Third Party Administration (Health) services (TPA) Claims and Preauthorization Processing HealthCare Assistance Services High Ratio Claims Management in coordination with Networking and Empanelment Department Monitoring the overall operations of Claims and Preauthorization. Responsible for ensuring efficient response at the level of Preauthorization to maintain TAT. Ensure adherence to processes and controls. Creating the process for claim processing (Cashless and Reimbursement). Co-ordination between Network Hospitals/Preauthorization/Claims. Ensuring a high-quality patient care at customized/optimized cost. Creating the process for claim processing (Cashless and Reimbursement). Preferred candidate profile • Good Excellent oral and written communication, negotiation, and decision-making skills. • Good customer service/relationship skills and ability to work effectively in a fast-paced environment with shifting priorities . Must be willing to work in non - clinic TPA EXPERIENCE mandatory.Clinical Exp.
Role & responsibilities To give Claims & Cashless/preauthorization, and scrutiny Medical Reimbursement Claims, and to Process Claims Third Party Administration (Health) services (TPA) Claims and Preauthorization Processing HealthCare Assistance Services High Ratio Claims Management in coordination with Networking and Empanelment Department Monitoring the overall operations of Claims and Preauthorization. Responsible for ensuring efficient response at the level of Preauthorization to maintain TAT. Ensure adherence to processes and controls. Creating the process for claim processing (Cashless and Reimbursement). Co-ordination between Network Hospitals/Preauthorization/Claims. Ensuring a high-quality patient care at customized/optimized cost. Creating the process for claim processing (Cashless and Reimbursement). Preferred candidate profile • Good Excellent oral and written communication, negotiation, and decision-making skills. • Good customer service/relationship skills and ability to work effectively in a fast-paced environment with shifting priorities . Must be willing to work in non - clinic TPA EXPERIENCE mandatory. Clinical Exp.
Roles and Responsibilities Ensuring a positive and professional client service experience. Managing client inquiries via phone, email, online, or in person. Directing client complaints or complex queries to relevant departments in a timely manner. Providing clients with technical assistance on products and services. Expediting serious issues to management toward prompt resolution. Building positive client relations by checking in regularly and following up on active processes. Maintaining client records and documenting processes. Identifying potential client services concerns and facilitating proactive intervention steps. Keeping track of new products on offer, as well as emerging trends in client services. Recommending product improvements based on client services feedback. Desired Candidate Profile 1- 4 years of experience in client services, sales, or a similar role. Exceptional ability in providing professional, efficient, and friendly client services. Ability to coordinate with other departments on client-related matters. Advanced ability to provide technical assistance, resolve issues, and recommend improvements. Willingness and the ability to travel to client locations, when required. Ability to keep updated on new developments in the field of client services. Excellent interpersonal and recordkeeping skills.
The candidate must have completed BHMS, BAMS, or BUMS from a reputed university." Experience : 0 to 2 years Locations : Bangalore, Chennai and Mumbai / Pune Role & responsibilities To give Claims & Cashless/preauthorization, and scrutiny Medical Reimbursement Claims, and to Process Claims Third Party Administration (Health) services (TPA) Claims and Preauthorization Processing HealthCare Assistance Services High Ratio Claims Management in coordination with Networking and Empanelment Department Monitoring the overall operations of Claims and Preauthorization. Responsible for ensuring efficient response at the level of Preauthorization to maintain TAT. Ensure adherence to processes and controls. Creating the process for claim processing (Cashless and Reimbursement). Co-ordination between Network Hospitals/Preauthorization/Claims. Ensuring a high-quality patient care at customized/optimized cost. Creating the process for claim processing (Cashless and Reimbursement). Preferred candidate profile • Good Excellent oral and written communication, negotiation, and decision-making skills. • Good customer service/relationship skills and ability to work effectively in a fast-paced environment with shifting priorities . Must be willing to work in non - clinic
Role & responsibilities Key Responsibilities: Serve as the primary point of contact for clients regarding medical insurance claims and policy-related queries. Assist clients with claim documentation, submission, and tracking. Liaise with insurance companies, brokers, and hospitals for smooth processing of claims. Provide guidance to clients on claim eligibility, coverage details, exclusions, and procedures. Resolve client issues and escalate complex cases to relevant departments as needed. Maintain updated records of all client interactions, claims, and documentation. Conduct periodic reviews and follow-ups with clients to ensure satisfaction and timely resolution. Educate clients on changes in policy terms, procedures, or regulatory updates. Support new client onboarding by explaining service processes and setting expectations. Collaborate with internal departments. Preferred candidate profile Min 4 years of experience in client servicing, preferably in the health or medical insurance sector. Strong understanding of health insurance terms, claim processes, and TPA coordination. Excellent communication and interpersonal skills. Problem-solving mindset and ability to handle pressure. Proficiency in MS Office. Knowledge of IRDAI regulations is a plus.
Role & responsibilities Build and maintain long-lasting relationships with clients, serving as their primary point of contact. Understand client needs and work with internal teams. Address client queries, issues, and complaints in a professional and timely manner. Liaise with various internal departments to ensure client satisfaction and the timely fulfilment of services. Preferred candidate profile Any graduate with relevant experience required OR MBA Fresher. Looking for candidate with long term commitment. Interested candidates can mail resumes to moulika.r@fhpl.net
Role & responsibilities To review Health Insurance cases referred for investigation and allocate to field investigators. Guide, follow-up with field investigators in closure of cases assigned as per the SLA of clients. Review the investigation reports submitted by the field investigators and give recommendation on authenticity of claim. Lead team of local internal investigators Maintaining data and updating in systems Ability to conduct digital verification, tele verifications and desktop verifications. Conduct data analytics and identify trends in fraud and medical abuse. Field investigation into high value claims and suspicious claims Out of box thinking skills to identify possible leads, patterns, and emerging trends in frauds/ Medical abuse. Healthy liaison with Insurance Companies and Brokers Submission of necessary reports as desired by the Client partners. Identify vendor partners for field verification and support capacity building Generate savings and support cost containment for the organisation as well as Clients. Must possess excellent soft skills, Problem solving ability and display a high level of integrity. Develop market intelligence and collaborate with industry partners for fraud risk mitigation The candidate must be a team player. Preferred candidate profile BHMS/BUMS/BAMS registration certificate is must. Willing to work for Insurance TPA and from office. Interested candidates can reach to Moulika @9177141222, moulika.r@fhpl.net
Desired profile: 5-7 years of experience in health insurance operations and client relationship management. Ability to manage external stakeholders in engaging them. Strong analytical and data interpretation skills. Good knowledge on health insurance statistics. SLA and compliance management. SOPs implementation and monitoring. Good presentation skills and decision making abilities. Able to manage multitasking environment where multiple co-ordinations with internal and external stakeholders are involved. Team handling. MBA is preferred or any graduation is must. Interested candidates can reach to Moulika @9177141222, moulika.r@fhpl.net
Role & responsibilities Build and maintain long-lasting relationships with clients, serving as their primary point of contact for Insurance TPA. Understand client needs and work with internal teams. Address client queries, issues, and complaints in a professional and timely manner related to insurance claims processing. Liaise with various internal departments to ensure client satisfaction and the timely fulfilment of services. Preferred candidate profile Any graduate with relevant experience required. Looking for candidate with long term commitment. Interested candidates can call or mail resumes to Moulika @9177141222, moulika.r@fhpl.net
Role & responsibilities Build and maintain long-lasting relationships with clients, serving as their primary point of contact for Insurance TPA. Understand client needs and work with internal teams. Address client queries, issues, and complaints in a professional and timely manner related to insurance claims processing. Liaise with various internal departments to ensure client satisfaction and the timely fulfilment of services. Preferred candidate profile Any graduate with relevant experience required. Looking for candidate with long term commitment. Interested candidates can call or mail resumes to Moulika @9177141222, moulika.r@fhpl.net
Role & responsibilities Team management: Supervise and guide a team of claims processors, delegating tasks, setting performance goals, and conducting regular performance reviews. Claim processing oversight: Monitor and manage the day-to-day workflow, ensuring claims are processed accurately, efficiently, and in a timely manner. Quality assurance: Review claims submissions to ensure they are compliant with policy terms, conditions, and relevant healthcare regulations. Problem-solving: Investigate and resolve complex and escalated claims issues, including discrepancies, in an accurate and timely manner. Training and development: Provide training and support to team members to enhance their skills and knowledge of claims processing and best practices. Process improvement: Collaborate with leadership to identify and implement process improvements to increase efficiency, accuracy, and service delivery. Compliance and reporting: Ensure adherence to internal controls, operational plans, and legal/regulatory requirements. Maintain accurate records and may be responsible for creating reports on team performance. Communication: Serve as a point of contact for inquiries, liaising with policyholders, healthcare providers, and other internal and external stakeholders. Preferred candidate profile BHMS/BUMS/BAMS graduates with registration. 5-8 years relevant experience in Insurance TPA. Willing to work from office. Interested candidates can reach to Moulika @9177141222, moulika.r@fhpl.net
Role & responsibilities Organize, file, and archive large volumes of physical and digital documents, including insurance applications, policies, claims forms, medical records, and legal contracts. Review and audit documentation for completeness, accuracy, and adherence to company policies and industry regulations. Accurately enter client and policy data into insurance management systems and databases, ensuring all records are up-to-date. Assist the claims department by collecting necessary documentation, verifying facts of loss, and ensuring all required paperwork for claim settlement is complete and accurate. Collaborate with insurance agents, underwriters, claims adjusters, clients, and other departments to gather information, resolve discrepancies, and ensure a smooth workflow. Identify opportunities to streamline documentation processes, implement efficient workflows, and assist in developing standard operating procedures (SOPs) and templates. Participate in internal and external audits and regulatory inspections, providing necessary documentation upon request and ensuring all practices meet legal and regulatory requirements. Respond to inquiries from clients or other stakeholders regarding policy details, claims status, and documentation requirements in a professional and timely manner. Preferred candidate profile Any enthusiastic graduate who has experience in Health Insurance claims processing and willing to travel. Interested candidates can reach Moulika @9177141222, moulika.r@fhpl.net
Role & responsibilities Build and maintain long-lasting relationships with clients, serving as their primary point of contact for their employees who walkin to helpdesk & having health insurance related queries. Understand client needs and work with internal teams. Address client queries, issues, and complaints in a professional and timely manner related to insurance claims processing. Liaise with various internal departments to ensure client satisfaction and the timely fulfilment of services. Preferred candidate profile Any graduate with relevant experience required. Willing to work at client location and respond to calls in timely manner. Interested candidates can call or mail resumes to Moulika @9177141222, moulika.r@fhpl.net