5 Insurance Cases Jobs

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 If candidates are interested please drop your update resume/CV on varsha.kumari@mediassist.in Thanks & Regards Varsjha Kumari Email - varsha.kumari@mediassist.in

Interested Candidates may connect with Ms.Aditi Anand-+91 78170-00490 (11am-5pm) About the Role: We are seeking a highly motivated and experienced individual with a medical background to join our dynamic team as a Medical Claims Call Center Representative. In this role, you will be the frontline of our customer service, handling inbound calls related to medical claims and rejections. Your primary focus will be to provide exceptional customer service while resolving inquiries and concerns effectively, ensuring a positive experience for every Niva Bupa member. Key Responsibilities: Answer incoming customer calls promptly and professionally. Assist customers with navigating medical claims, including inquiries about submissions, rejections, and procedures. Provide accurate and detailed information about claim processes, documentation requirements, and insurance coverage. Investigate and resolve customer concerns with a focus on high satisfaction and clear communication. Collaborate with internal departments like claims processing to address complex issues and expedite resolutions. Maintain extensive knowledge of Niva Bupa products, medical billing codes, and claim procedures. Document customer interactions and update records accurately in our system. Identify and escalate critical or unresolved issues to the appropriate supervisor. Adhere to company policies, procedures, and compliance guidelines. Key Requirements: Education & Certificates: Any Life science, Paramedical, Medical Graduate or Post-Graduate (Pharmacy, Physiotherapy) or equivalent degree. Minimum 1-3 years of call center experience, preferably in healthcare or medical insurance. Strong knowledge of medical terminology, insurance claim procedures, and billing codes. Excellent verbal and written communication skills. Ability to handle high call volumes and prioritize customer needs effectively. Strong problem-solving and decision-making abilities. Attention to detail and accuracy in data entry and documentation. Exceptional customer service skills with a friendly and professional demeanor. Proficiency in computer systems, including CRM software and Microsoft Office Suite. Ability to work effectively in a team-oriented environment. Flexibility to work various shifts as per business requirements. What you'll gain? A competitive salary package of up to Rs. 3.5 LPA, based on your experience and Interview performance. Be part of a growing and respected healthcare company. Make a real difference in the lives of our members by providing exceptional customer service. Work in a dynamic and supportive environment with opportunities for growth and development. Competitive salary and benefits package. Ready to join Niva Bupa and contribute to a team dedicated to improving lives? Apply today!

Greetin from Medi assist TPA We are Hiring Hospital Coordinator Health insurance sector J.D Role Overview: As a Care Manager, one will be responsible for cultivating and maintaining strong relationships with our clients' CXOs/Senior leaders/Raksha Prime members to ensure their needs are met and expectations exceeded. This role requires a candidate with a minimum of 3 years of experience in the service industry, with a proven track record of excellence. The ideal candidate will possess exceptional empathy, impeccable verbal and written communication skills, and a deep commitment to client satisfaction. Thanks & Regards Hariprasad.M Email : hariprasad.m@mediassist.in

Ford Hospital is looking for Corporate & TPA Billing Executive to join our dynamic team and embark on a rewarding career journey. Assisting with the preparation of operating budgets, financial statements, and reports. Processing requisition and other business forms, checking account balances, and approving purchases. Advising other departments on best practices related to fiscal procedures. Managing account records, issuing invoices, and handling payments. Collaborating with internal departments to reconcile any accounting discrepancies. Analyzing financial data and assisting with audits, reviews, and tax preparations. Updating financial spreadsheets and reports with the latest available data. Reviewing existing financial policies and procedures to ensure regulatory compliance. Providing assistance with payroll administration. Keeping records and documenting financial processes.

Key Responsibility Areas (KRA) Hospital TPA Desk Executive Designation: MDIndia TPA Desk Executive Location: Assigned Hospital Reporting To: MDIndia Provider Management Head Office 1. Claims Processing & Coordination Facilitate the Green Channel process to ensure zero waiting time for patient admissions and discharges. Prioritize and assist with the admission of VIP clients and corporate patients for a seamless experience. Support the end-to-end processing of cashless and reimbursement claims efficiently. Coordinate with the hospital billing and finance team for smooth claim approvals and disbursements. Liaise with the Head Office to resolve claim-related issues promptly. 2. Patient Assistance & Query Resolution Serve as the single point of contact for patients regarding their insurance claims for the specific hospital. Educate patients and their families about the claim process, required documentation, and eligibility criteria . Address and resolve patient grievances related to claims processing, escalating unresolved issues when necessary. 3. Hospital Liaison & Relationship Management Maintain strong professional relationships with hospital administrators, doctors, and billing teams. Collaborate with hospital staff to ensure seamless admission and discharge procedures for insured patients. Conduct regular meetings with hospital management to streamline TPA processes and improve service efficiency. 4. Reporting & Communication Prepare and submit daily/weekly reports on claim status, patient queries, and pending cases to the central office. Communicate any hospital-specific challenges, delays, or process gaps to management for quick resolution. Stay updated with latest TPA policies, regulatory guidelines, and hospital agreements . 5. Fraud Prevention & Risk Mitigation Adhere to strict protocols to prevent fraudulent activities in claims processing. Ensure seamless coordination with the MDIndia Head Office team to mitigate risks. 6. Customer Service & Satisfaction Provide prompt support and clear guidance to insured patients for a positive customer experience. Conduct feedback sessions to identify patient concerns and suggest process improvements. Enhance customer satisfaction by reducing waiting time for admissions, claims, and grievance resolution. 7. Wellness & Value-Added Services Coordination Coordinate with hospital teams for VIP health checkups, doctor consultations, and second opinion arrangements . Organize OPD service arrangements in the hospital for insured patients. Inform the Head Office team about new hospital initiatives and developments. Keep the Head Office updated on competitor processes and industry trends for strategic planning. Key Performance Indicators (KPIs) 1. Turnaround Time (TAT) – Speed of priority admissions and discharges. 2. Claim Accuracy Rate – Number of claims processed without discrepancies. 3. Patient Satisfaction Score – Feedback from patients and hospital staff. 4. Compliance Adherence – Ensuring 100% compliance with regulatory requirements. 5. Hospital Coordination Efficiency – Effectiveness of hospital staff and management liaison. 6. Query Resolution Time – Average time taken to resolve patient/hospital queries. 7. Wellness Service Delivery – Efficiency in coordinating VIP checkups, OPD services, and second opinions.