272 Health Claims Jobs - Page 4

• 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. Interested candidate can share your resume to varsha.kumari@mediassist.in

Resolve customer queries over calls, chat Address and resolve customer complaint or issues related to healthcare services Inform customers about health plans, insurance coverage, and healthcare service connect Hr Harshita - 84450 22026 Required Candidate profile Excellent communication skills in English Only B.Pharma/ M.Pharma/ D.Pharma passed Freshers or Experienced can apply Strong understanding of medical terminology Immediate Joiners Rotational shifts Perks and benefits Incentives Health Insurance

Roles and Responsibilities Provide health coaching services to patients, focusing on patient care and counseling. Assist doctors in managing patient relationships and ensuring effective communication between patients, families, and medical professionals. Support healthcare operations by coordinating with various departments to ensure seamless delivery of healthcare services. Collaborate with health management teams to develop strategies for improving patient outcomes through data-driven decision making.

"Get a exposure to work in Top Notch Global Health care organization as a intern" * Only BCOM,BBA , BA, BSC,BBM Graduates can apply ( NO BE/BTECH AND MBA/ POST GRADUATES * Only 2023,2024,2025 GRADUATES CAN APPLY ( Provisional certificate is mandatory) Position Requirements & Key Details: Contract Duration: 6-month contract with potential for conversion to a permanent role based on performance Rotational Shifts: Which include night shift( Candidate must open to work night shift based on business requirement) Transportation: Two-way company-provided transportation for all shifts Training: Comprehensive 3-week training covering domain knowledge and essential Excel skills Opening is for one of the Global Healthcare Company Position : Enrollment Claims (Business Operations) Job Description : Analyze insurance claims in accordance with standard operating procedures Resolve routine issues by following established guidelines and precedents Collaborate primarily with your team and direct supervisor; all tasks will come with clear instructions Understand and apply process documents provided by the client Navigate and work across multiple client applications to capture and process required information Consistently meet targets related to productivity, schedule adherence, and quality Comply with all company policies and procedures Interested Candidate can share your updated resume/contact for further clarification thulasi.r@ascent-online.com / 8105586998 Regards Talent Acquisition Specialist Thulasi R 81085586998

Wipro hiring for Insurance US insurance profile in Kolkata location. We are hiring Any Under Graduate/Graduate fresher OR Experienced. Candidate must be comfortable with WORK FROM OFFICE. *Must BE* The candidate must have good verbal communication skills. The candidate must be staying or ready to relocate to Kolkata. As it is WORK FROM OFFICE. Roles and Responsibilities Candidate will take care of Insurance claims of International customers. Desired Candidate Profile Any Grad fresher- 3 Lakhs Experienced- 3 Lakh + Inc.+ Cabs Other Details- Fixed Shift time- US shifts Complete Inbound Voice Profile Cabs in odd hours only If you are meeting the above requirements. Then please please call our recruiter. Click on Apply NOW Tab Contact: Ravinder Singh Rawat

Claims Executive Responsibilities: Receiving and answering emails, telephone calls related to claims Advice policyholders on claim procedure Ensure fair settlement of a claim with TAT Manage all administration aspects of the claim Adhere to legal requirements, industry regulations and customer quality standards set by the company. Handle any complaints associated with a claim Claims Executive Requirements: A bachelor's degree in any discipline. At least 2-4 years' experience as a claims handler or a similar role. Excellent time management skills and organizational abilities. Top-notch client interaction skills. Ability to work in a high-pressure environment. A general understanding of insurance terminology and abbreviations. Attention to detail and process-orientated thinking. The ability to work independently and multitask. Proficient in basic computer handling.

You are seeking fresher to gain experience in Health Claims. You will be required to go through a few days of training and will be responsible for accurately processing and adjudicating medical claims in accordance with company policies, industry regulations, and contractual agreements. Your responsibilities will include reviewing and analyzing medical claims submitted by healthcare providers for accuracy, completeness, and compliance with insurance policies and regulatory requirements. You will need to verify patient eligibility, insurance coverage, and benefits to determine claim validity and appropriate reimbursement. Additionally, you will be assigning appropriate medical codes (e.g. ICD-10, CPT) to diagnoses, procedures, and services according to industry standards and guidelines. Adjudicating claims based on established criteria including medical necessity and coverage limitations will be a crucial part of your role, ensuring fair and accurate reimbursement. You will be expected to process claims promptly and accurately using designated platforms, investigating and resolving discrepancies, coding errors, and claims denials through effective communication with healthcare providers, insurers, and internal teams. Collaboration with billing, audit, and other staff to address complex claims issues and ensure proper documentation and justification for claim adjudication will also be essential. To excel in this role, you should maintain up-to-date knowledge of healthcare regulations, coding guidelines, and industry trends to ensure compliance and adherence to best practices in claims processing. Providing courteous and professional customer service to policyholders, healthcare providers, and other stakeholders regarding claim status, inquiries, and appeals is a key aspect of the position. Documenting all claims processing activities, decisions, and communications accurately and comprehensively in the designated systems or databases will be required. Ideal candidates for this position would hold a Masters/Bachelors degree in fields like Nursing, B.Pharma, M.Pharma, BPT, MPT, or a related field. Excellent analytical skills with attention to detail and accuracy in data entry and claims adjudication are essential. Effective communication and interpersonal skills, along with the ability to collaborate across multidisciplinary teams and interact professionally with external stakeholders, are highly valued. Demonstrated ability to prioritize tasks, manage workload efficiently, and meet deadlines in a fast-paced environment is crucial. A problem-solving mindset with the ability to identify issues, propose solutions, and escalate complex problems as needed is also desired. A commitment to continuous learning and professional development in the field of healthcare claims processing is expected from all candidates.,

Job Title: Sr Manager Health Insurance Claims Location: Bangalore (Hybrid) Company: Pazcare Type: Full-time About Pazcare Pazcare is transforming employee healthcare and wellness for 2000+ companies including Mamaearth, Chaayos, Mindtickle, and more. We simplify health insurance and wellness benefits, giving HR teams superpowers through real-time claim tracking, analytics, and stellar employee experiences. Role Overview As a Claims Manager, you will be the frontline owner of ensuring claims are settled within the agreed turnaround time (TAT) across TPAs. You will play a critical role in driving TPA performance, resolving escalations, and advocating on behalf of our clients to ensure no valid claim is wrongly repudiated. Key Responsibilities Ensure all reimbursement and cashless claims are processed within the committed TAT across clients. Track, analyze, and manage TAT performance of multiple TPAs; escalate and hold them accountable for delays or service gaps. Reopen wrongly repudiated claims with TPAs/insurers and fight for fair resolution on behalf of clients. Collaborate closely with the customer success and insurance teams to address claim escalations proactively. Drive continuous process improvement in claims handling and communication workflows. Maintain internal dashboards and reports to track SLAs and spot trends. Requirements 3+ years of experience in health insurance claims (TPA/insurance broker/insurer preferred). Strong understanding of reimbursement, cashless claim processes, and IRDAI guidelines. Assertive communicator with negotiation skills to handle TPAs and insurers. Analytical mindset with ability to identify patterns in delays or rejections. Empathy for the end user the employee or HR dealing with a health issue. Why Join Pazcare? Work with a mission-driven, fast-growing team redefining how India experiences employee health benefits. Ownership of high-impact outcomes and the opportunity to shape the future of claims at scale. Be part of a culture that values transparency, speed, and customer-first thinking.

Role & responsibilities - manage risk across claims and underwriting processes. This leadership role requires close collaboration with multiple internal teams, including Claims, FWA, Retail Underwriting, Sales and Actuarial departments, to drive business performance, ensure regulatory compliance, and maintain effective governance. Monitor overall claims and underwriting portfolio performance by analyzing trends throughout Channels. Collaborate with Channel Heads and ground teams to define actionable plans for addressing unproductive or loss-making claims segments, fraud identification and prevention; etc. Lead initiatives to reduce claims costs, mitigate losses in unprofitable cohorts, and improve customer experience Conduct process reviews to identify and control processing errors, transaction outliers, and implementation risks. Develop and execute risk mitigation strategies to ensure smooth adoption of new processes and strategies. Manage audits and resolve findings related to Claims and Underwriting, including IRDA, internal, statutory, and other audits. Lead quality checks for processed claims (in-house and TPA) through concurrent/retrospective audits and system validation. Conduct audits of NEFT/Payment processes and clinical coding to ensure accurate system adjudication and effective data analytics. Enhance documentation and reporting accuracy within the Claims function. Oversee governance within the Claims and Underwriting teams to align with company objectives.

Roles and Responsibilities Manage a team responsible for investigating fraudulent activities related to health claims. Conduct thorough investigations into suspected cases of insurance fraud, gathering evidence and interviewing witnesses as needed. Develop and implement effective strategies to prevent future instances of fraud through risk control measures. Collaborate with other teams within the organization to ensure seamless communication and coordination during investigations. Ensure compliance with regulatory requirements and company policies throughout all aspects of claim investigation.

Responsibilities: Ensure timely claim settlements within policy limits. Manage health claims from intake to payment. Process mediclaim & TPA claims with accuracy. Collaborate with insurers on claim resolution. Health insurance Annual bonus

Positions General Duties and Tasks: Process Insurance Claims timely and qualitatively Meet & Exceed Production, Productivity and Quality goals Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities Analyze customer queries to provide timely response that are detailed and ordered in logical sequencing Cognitive Skills include language, basic math skills, reasoning ability with excellent written and verbal communication skills Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing Continuous learning to ramp up on the knowledge curve to be the SME and to be compliant with any certification as required to perform the job Be a team player and work seamlessly with other team members on meeting customer goals Developing and maintaining a solid working knowledge of the insurance industry and of all products, services and processes performed by Claims function Handle reporting duties as identified by the team manager Handle claims processing across multiple products/accounts as per the needs of the business Requirements for this role include: Both Under Graduates and Postgraduates can apply. Excellent communication (verbal and written) and customer service skills. Able to work independently; strong analytic skills. Detail-oriented; ability to organize and multi-task. Ability to make decisions. Required computer skills: Must have experience with data entry and word processing, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications. Demonstrate strong reading comprehension and writing skills. Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills. Ability to work in a team environment. Handling different Reports - IGO/NIGO and Production/Quality. To be in a position to handle training for new hires Work together with the team to come up with process improvements Strictly monitor the performance of all team members and ensure to report in case of any defaulters. Encourage the team to exceed their assigned targets. Candidate should be flexible & support team during crisis period Should be confident, highly committed and result oriented Experience on working in an office environment set up utilizing Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools Experience in a professional/office related role that required you to communicate (oral/written) effectively with internal team members and external customers Experience in a role that required a focus on quality including attention to detail, accuracy, and accountability for your work product Candidate should be flexible to work from home and office environment. Broadband connection is must while working from home. Preferences for this role include: 3+ years of experience processing insurance claims in the health, life, or disability disciplines that required knowledge of CPT, HCPCS, ICD9/10, CDT. 2+ year(s) of experience in role that required understanding and interpreting complex documents such as medical records and legal contracts. ***Required schedule availability for this position is Monday-Friday 6PM/4AM IST . The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement."

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 Mumbai/Bangalore Educational Qualification Shift BHMS, , BAMS, MBBS(Indian registration Required) 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

Hiring for leading MNC company Interview Mode: Face-to-Face Interview Location: Noida & Gurgaon Exp Req: 0 to 5 Yrs Qualification: BPT, MPT, BUMS, BAMS, BHMS only Key skills: Claim Processing, Knowledge of Healthcare and coding, Knowledge of health insurance, CPT, CMC Work mode: WFO 5 days working Weekends fixed off Cabs available Salary: up-to 5 LPA Interview Dates: Gurgaon: 12/7/2025 (Saturday), 15/7/2025 (tuesday) Noida: 15/7/2025 (tuesday) Interested candidates call or WhatsApp on this number: 8700871235. Share your Cv on this email: amanaxisconsulting@gmail.com

Join our dynamic international business team across Bangalore and Hyderabad Job Description Claims Service Support (CSS) - AM/Manager Summary: We at Prudent Insurance Brokers, are seeking an experienced Employee Benefit-Claims Service Support professional for our International Business (IB) vertical. Employee Benefits Practice at Prudent is a strategic business unit dedicated to strengthening Prudent’s global brand in the international market. The individual will be responsible to Serve as primary point of contact for all employee claim queries etc. We are committed to delivering bespoke Benefit & Total Reward Solutions with high standards of service excellence, world-class advisory and consultancy support for MNC clients who have their operations in India. Our team forms a bridge of trust between the expectations of senior stakeholders globally and the seamless delivery of these best practices in India. Roles & Responsibilities: • 1) Exceptional Employee Experience Support system by Prudent Serve as primary point of contact for all employee claim queries and own the process of developing strong employee relationships & engagement 2) Facilitating the cashless and reimbursement process: Ensuring employees understand the steps involved in both cashless and reimbursement claims. Offering exceptional support and guidance to employees/HR throughout the entire process to ensure a smooth experience. 3) E-cards/network hospitals: To provide employees e-cards and information about network hospitals. 4) Providing claim-related queries: Addressing questions about claim status, claim deductions, and explanations of queries. 5) TPA Co-ordination: Co-ordinating with TPA daily to ensure the smooth functioning of employee-related queries 6) Employee Engagement & Support SPOC: Daily tracking of claims on status/rejections/deductions and providing the report to MCS Desired profile/who should join: Good listening & communication skills Should have good technical knowledge about Employee health Insurance/ General Insurance products. (Cashless/Reimbursements) Experience in General Insurance/ Insurance Brokers Years of experience: 2 to 5 years Education qualification: Bachelor's Degree, Master's Degree Good knowledge of the TPA/Insurance processes Well-versed in health insurance policy conditions Well-versed with current medical practices & advancements Should know about IRDAI health regulation If the opportunity interests you, kindly share your updated CV with Tanay Srivastava (tanay.srivastava@prudentbrokers.com) or Yogesh Nagar (Yogesh.nagar@prudentbrokers.com) with the subject ‘’Claims role_*Location*’’ Role & responsibilities

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 Interested candidates can share their CVs to Dona- 9632777628

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

Clients business problem to resolve : At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees are key factors in our companys growth, market presence and our ability to help our clients stay a step ahead of the competition. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here. Clients Business problem to solve? Our Client is one of Leading Health Plan in US providing services in Florida state , NTT are getting into contract with Client to manage End to End Claims Administration services. Our NTT Business Process Outsourcing (BPO) team has implemented the processes and technologies for our clients bring about real transformation for customers of all sizes. Our end-to-end administrative services help streamline operations, improve productivity and strengthen cash flow to help our customers stay competitive and improve member satisfaction. Positions General Duties and Tasks: NTT are getting into contract with Client to manage End to End Health Claims Administration services. Our NTT Business Process Outsourcing (BPO) team has implemented the processes and technologies for our clients bring about real transformation for customers of all sizes. Our end-to-end administrative services help streamline operations, improve productivity and strengthen cash flow to help our customers stay competitive and improve member satisfaction. Requirements for this role include: Must have strong Health Claims End to End Domain Knowledge. Minimum 2+ years as Team lead/Asst.Manager Both Under Graduates and Post Graduates can apply. Excellent communication (verbal and written) and customer service skills. Ability to work independently; strong analytic skills. Detail-oriented, ability to organize and multi-task. Ability to make decisions. Required computer skills: Must have experience with data entry and word processing, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications. Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills. Ability to work in a team environment. Problem Solving Reviews structured problems. Selects and applies appropriate standards/guidelines. Probes beyond the stated situation. Identifies underlying issues and consider possible alternatives. Job Duty Differentiators: Supervises processes and/or claims processing teams ensuring highest quality of service is provided. Includes the distribution of work, calculation and communication of productivity and quality results and review of audit appeals. Monitors production goals of team and reports results and issues to higher-level leadership. Assists team with escalated claims processing issues. **Required schedule availability for this position is Monday-Friday 6PM/4AM IST The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement.

Claims processing Doctor Job Description: Medical claims processor will have to look into claims where payment was denied. Commonly due to issues of insurance coverage eligibility, the claims handler may be tasked with reviewing documentation from the patient, their physicians, or the insurance. With the medical expertise ,need to master the various products and to apply the same during claim processing. Claims processors process any claim payments when applicable and must ensure they comply with federal, state, and company regulations and policies. List of Responsibilities: To validate the authenticity and the credibility of the claims. To coordinate with various persons (Claimant, Treating Physician, Hospital insurance desk, Field Visit Drs, Investigation officers)for hassle-free claim processing . To expertise ,the process of negotiation when necessitated. The claim handler owes a duty of care to the patient, ensuring that their needs are being met and that they re receiving the treatment or medicine they need. Job Qualifications and Requirements: Required BDS, BHMS, BAMS, MD, Pharm D Graduates. Adapt and inbuilt the process of communication and coordination across the zones and the supporting verticals accordingly.

Basic Function Handle and administer Family & Medical Leave Act standalone (as well as other leave) claims and adhere to federal and state regulatory and/or company plan requirements and established FMLA workflow procedures Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee, physicians office or employer through outgoing calls, email, fax or other supporting systems. Promptly review new FMLA and other leave claims within regulatory timelines, evaluate against appropriate leave plans and make initial claim decision. Perform leave administration tasks as required, including recertification of health condition, intermittent claim tracking, RTW confirmation, return phone calls, etc. Update systems to accurately reflect leave status and ensure appropriate diary documentation exists Business recommended TAT to complete the activity is up to 5 business days to maintain compliance measures The position is expected to do absence management and adjudication on Federal, State and company leaves. Interact with claim specialist, claim support specialist, QA, Claims Unit Leader (stateside supervisors), employees, employers/customer and physicians office Essential Functions: Analyze, validate and process transactions as per Desktop procedures (L3 & L4) Analyze and research all discrepancies Research & Investigate and resolve outstanding items Determine eligibility, entitlement and applicable plan provisions while meeting timeliness goals Clear and accurate written and verbal communication (Mix of scripted/unscripted) with employee, employer & stateside resources by email and outgoing calls Establish action plans for each file to bring claims to resolution Utilize internal and external specialty resources to maximize impact on each claim file Use PC programs to increase productivity and performance Ensure that the assigned targets are met in accordance with SLA, Performance Guarantee and Internal standards Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence Work as a team member to meet office goals to obtain disabilitys vision while demonstrating core values and meeting key measures Ensure adherence to established attendance schedules Close visual activity - viewing a computer terminal and extensive reading To apply call Miss Jaspreet Kaur at 9667037957

Role & responsibilities Claims adjudication, claims approval, TAT, accuracy, productivity, claims cost, fraud and leakage control, client/provider feedback, team training and retention Preferred candidate profile Processing claims, quality check and adherence to TAT, fraud triggers, fraud risk assessment, computer skills. Candidate should be open to work in 24X7X365 environment Microsoft office proficiency Knowledge of Indian Health Care and prior experience in Health Insurance Claim Processing, Good Clinical Acumen Minimum 1-3 Years Preferred Industry Health Insurance/TPA/Hospital / Clinical Practice/heath care/ wellness etc.. Minimum- Medical Graduate (BDS/BAMS/ BHMS/BPT/ BUMS) Preferred Location Indore Surat Mumbai Nagpur Chennai Bangalore Kochi Kolkata Noida Hyderabad Vishakapatnam Chandigarh Vadodara

Looking for an Accounting Receivable Specialist with 1+ year of U.S. medical billing experience, knowledge of EOBs, denials, CPT codes, and U.S. insurance. Must work U.S. shifts from Pune. Healthcare experience required. Provident fund

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 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. Isha Thakur 9056448144 HRD

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 Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Mumbai/Bangalore Educational Qualification Shift BHMS, , BAMS, MBBS(Indian registration Required) 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