184 Mediclaim Jobs - Page 4

Role & responsibilities Serve as a point of contact for Insurance related inquiries Create a consistent, positive work atmosphere through the communication Close interaction with respective department at hospital To interact with hospital insurance patients. Interact with Hospital Management, Doctors, Medical and non-medical staff at the hospital To create awareness about insurance claims (reimbursement and cashless claims, pre & post hospitalization claims etc.) Collecting claim support documents from the patients / hospitals & coordinate with backend team to ensure smooth transfer of data to the TPA/Insurance Company. Send the pre auth request and follow up on cashless approval form insurance company. Efficiently and effectively handle grievance / issue raised by hospital staff & patients, escalate issue to the team leader, as when necessary. Follow-up and Updates to be given to the clients Required Skills and Experience Education: Any Diploma, Graduation, or Under Graduation. Experience: 6 months to 1 year in hospital or insurance roles (preferred). Strong communication and problem-solving skills. Ability to multitask, prioritize, and work efficiently. Detail-oriented with a professional and confidential approach.

Fortis Hospital Mohali is hiring for following vacancies; 1. OPD 2. IPD 3. TPA 4. Counsellor interested candidates can come directly for the interview as per schedule or share resume at baljinder.singh@fortishealthcare.com

Responsibilities: * Ensure accurate Hospital Billing of cash/insurance patients. * Manage TPA claims from submission to settlement * Collaborate with insurance companies on claim resolution and settlement. Please contact 9326009595

Perform daily SLA Analyze and review daily fraud reports Identify and report suspected frauds and risks Process Daily Payouts Accounts Verifications Updating routine records of findings and action taken along with proper reasoning Proactively highlighting the risk and fraud mitigation areas Responding to customer as we'll as internal queries with appropriate resolutions Requirement Has knowledge of card games Experience of working in fraud compliance domain in consumer facing Industry Excellent analytical, investigative and data interpretation skills High Conflict Management and Problem-Solving skill Ability to work under pressure and to deliver within given time frames Good interpersonal skills Good in written and oral communication skills Certificate course in Fraud and Risk management (not Mandatory) What we offer - 1. Competitive salary 2. Mediclaim Policy - Best in Industry 3. Flexible working hours 4. Career Development Program 5. Best in Industry Reward and Recognition program 6. Inclusive and Collaborative Work culture 7. Lunch is served everyday

To ensure that all underwriting placement/ client service requirements of clients are met as per Company defined TATs Structuring and sourcing quotes for fire, marine, property, engineering, liability, motor and other miscellaneous insurance policies of clients Ensuring optimal product coverage & premium pricing Negotiating with insurers for best rates terms Vetting policy documents received from insurers in terms of terms, coverage, etc., Timely reconciliation of each account Ensuring timely updation of data details in appropriate tools solutions Effectively coordinating between client insurers for any document collection handover Effectively coordinating with the TPA for daily service requirements Communicating with internal & external stakeholders as needed based on business requirements Accountable for deliverables pertaining to the areas assigned and responsible for results Background in underwriting of non-retail insurance products in essential Knowledge on marine & property underwriting is necessary Basic knowledge of premium pricing and product coverage Good communication skills Multi-tasking & prioritizing Strong interpersonal skills Networking & Collaborative Abreast with technology

Role & responsibilities To greet incoming patients or their representatives and to record complete information required for processing cashless facility. To hand over Pre-Auth form to patient and explain the procedure in detail. To process Initial approval, interim bill and final enhancement and co-ordinate with billing. To answer questions and to provide information directly to the person or on the telephone. For eg.Explaning Policy terms and conditions and hospital Policy regarding payment of bills. To prepare and maintain data of patients availing cashless facility and status, check payable report. To explain hospital regulations to patients, concerning Insurance process and discharge formalities. Preferred candidate profile B.Com with 1-5 years of revelant experience

Interested Candidates may connect with Ms.Zoya Shamsi +91 7251000195 (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: B.Pharm & M.Pharm. 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!

Responsibilities: * Manage claims from intake to settlement. * Adjudicate medical necessity & settle claims fairly. * Ensure timely claim payment & employer satisfaction. * Process mediclaim & health insurance claims accurately.

Key Responsibilities: Handle end-to-end reimbursement and cashless claims for corporate clients' employees and dependents. Scrutinize claim documents for completeness, medical validity, and compliance with policy terms. Coordinate with empaneled hospitals, insured members, and insurance companies for claim clarification, queries, and approvals. Maintain TAT and SLA commitments for smooth and timely processing. Ensure compliance with IRDAI guidelines and internal company SOPs. Update and manage claims data in the internal system accurately. Prepare and share MIS reports with internal stakeholders and corporate clients. Manage escalated and high-value claims with detailed attention and resolution

Job Description Acts as an interface between the TPA, Insurance Company and the hospital. Responsible for investigation of suspicious claims. Effective usage of Fraud control measures. Act as a backend support to the TPA. Responsible for data mining and analytics related to Fraud and Investigation (IFD) Field visit for investigation purpose. Open to travel. Desired Candidates Profile Qualification Any Graduate Experience Fresher - 2 Years Exp. Profile – Executive If interested kindly share your resume to recruitment1@mdindia.com

Resolve customer queries over calls, chat Address and resolve customer complaint or issues related to healthcare services, ensuring a positive and satisfactory experience Inform customers about health plans, insurance coverage, and healthcare service 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

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. Qualification: BAMS BHMS Work from office only Interested candidates can send their CV to varsha.kumari@mediassist.in

Job Description: Skills Required: Strong leadership, team management skills with Excellent communication and interpersonal skills Comprehensive understanding of hospital admission processes and billing systems Customer service oriented with problem-solving capabilities Ensuring accurate billing for services provided to inpatient (hospitalized) patients, including room charges, medical procedures, medications, and consultations. Leading and managing the team responsible for processing and generating bills for inpatient services. Collaborating with other departments like clinical, pharmacy, and insurance for timely and accurate billing. Overseeing day-to-day administration, directing and controlling of the IPD operations. Ensuring close adherence to prescribed Standard Operating Procedures (SOPs) in all functional areas. Organizing regular training inputs and organizing feedback sessions from Staff and Customers. Monitoring customer feedback on a day-to-day basis - acknowledges and take corrective action, wherever required. Interacting with Consultants in IPD and catering to their requirements. Oversee and streamline billing process and for the timely submission of medical claims to insurance companies Cross Checking of patients bills i.e. balance and final respectively. Taking any confirmation with IPA and coordinating with TPA for any deficiency in getting approval. Manages billing system updates and providing patient financial counseling Going over insurance pre-authorizations and verifications and tracking payment and payment plans. Educating the patients about their rights and responsibilities. To ensure timely and accurate compliance with the standards laid down under ISO for the departmental function. To handle inter and intra departmental coordination for smooth discharge. Preparing TPA approval as per given clauses and coordinating with Cash/ Corporate bill on daily basis. Authentication of documents CGHS/ PSU and same dispatch to concern for final payment. Post discharge checking of CGHS/ TPA bills. To ensure timely action on patient queries related to billing. To follow Cash / Credit / Corporate billing / discount instructions. To ensure accurate and timely Billing. Maintaining register for discharge flow. Checking of referral, approval and mandatory requirements of institutions. Package mapping during night hours. Updating OT sheets and assigning packages of Cath/ OT. Special vigil on international patient billing. To be well groomed, punctual & adhere to company policies and practices. To effectively utilize Hospital Information System and other software provided. To comply with the service quality process, environmental & occupational issues & policies of the respective area.

Inpatient/Outpatient Billing. Overseas/Corporate/Insured/TPA billing. Payment Tracking. Bed Management. TPA files follow-up and closure. Tracking of discounts/Cancelled bills/refunds/free bills/posting of packages. Service Recovery in the billing Area. Training of the HIS modules in billing with the power users.

Job Description (IFD) Communicating with clients and understanding the investigation requirements. • Meeting with clients to discuss the nature of the investigation. • Conducting field investigations on appointed cases, insurance claims, or client requests. • Conducting in-depth research on various appointed cases. • Decide the extent and validity of a claim, and in so doing, prevent fraudulent claims by determining the claim's authenticity. • Gathering and analyzing evidence reports. • Conducting photographic and audio surveillance to gather evidence • Reviewing and solving cases by authenticating insurance claims. • Coordinating with agents to understand insurance claims matters. • Answering to specific trigger in reports. • Manage multiple cases with confidence and accuracy and respond well to working to meet targets and tight deadlines. • Prepare reports, maintain records and keep track of evidence trails. Address - MD India Health Insurance TPA Pvt. Ltd. H.No.6-3-883/A/1 #: 201, 2nd Floor, imperial Plaza, Beside Topaz Building, Panjgutta, Hyderabad - 500082. Contact Number - 7030949730 ( Neha Nanoti )

Company Overview: Onsitego is India s leading after-sales service provider and offers Extended Warranty, Damage Protection, AMC Plans, and On-Demand Repair Services. We cover all electronic devices and home appliances. Our plans are widely available across retail stores and online marketplaces. We are driven by the mission to consistently deliver WOW experiences to customers. Our customer obsession allows us to have the highest Net Promoter Score (NPS) globally in after-sales services. Our hassle-free & reliable services are widely available across electronic stores and online marketplaces. We invite the brightest minds to join us in this journey that helps improve the lives of millions of device users across the country. Website: www.onsitego.com Job Title Associate Product Manager/ Product Manager Department Product Management Location Mumbai Job Purpose: As a APM / Product Manager, you will play a key role in our journey to shape the next chapter of engagement and growth strategy for Onsitego. In this cross-functional role you will be working with technology, business, marketing, design and executive teams to chart out the growth strategies. You should be able to break down complex problems into steps that drive product development, adoption and engagement. Responsibilities: Design, build, and maintain business applications that align with the companys business requirements and objectives. Integrate data sources between applications to ensure accurate and up-to-date information for planning and reporting purposes. Collaborate with end users to understand their needs and translate those requirements into solutions. Train and support end-users and clients, ensuring they can effectively utilize the business applications for decision-making and planning. Implement changes based on feedback and changing business needs. Produce and review product requirements documents (PRD). Work with senior product managers and/or executive team to create product plans and roadmaps. Desired candidate profile: Candidate should have 2+ years of experience managing high growth consumer or SaaS products. Background in engineering along with a MBA degree is preferred. Prior experience in working with different stakeholders in highly regulated, hyper-competitive landscape is a plus. Have developed product features and growth hacks using product management tools and frameworks. Write detailed product requirements and end to end use cases with effective user stories to be used by engineering & design teams. Refine product backlog. Creates clear & detailed low-fi or high-fi mock-ups using Lucid Chart, Figma or other tools. Experience on Product Management tools like JIRA, Confluence. Communication, persuasion and presentation skills. Experience: 2-3 years Qualification: MBA / BTech Benefits: We believe in work-life balance and hence we offer flexible working hours. What matters is the output of work. We have a well-defined leave policy for our people to take care of their personal commitments and exigencies. We care for our people and take care of them and their family by offering them Mediclaim policy Your professional growth and company growth go hand-in-hand We provide you a platform to learn and polish your skills

Job Summary: We are looking for a dynamic and experienced Manager Employee Benefits to join our team in Bangalore. The ideal candidate will have strong experience in employee benefits program management, relationship management, data analytics, and coordination with insurers and TPAs. Prior experience in a brokerage firm will be an added advantage. Key Responsibilities: 1. Client Relationship & Account Management: Act as the primary point of contact for assigned corporate clients. Build and maintain strong relationships with HR and employee stakeholders. Conduct regular review meetings with clients to understand needs, resolve issues, and offer strategic advice. Support renewals and policy upgrades through proactive communication and data insights. 2. Employee Communication & Support: Address employee queries and provide resolution related to group insurance policies, claims, endorsements, and benefit structure. Conduct employee awareness sessions on policies and claims processes. Manage escalations effectively and ensure timely resolution. 3. Insurance Operations & Coordination: Liaise with insurers and TPAs for smooth issuance, endorsements, claims processing, and reconciliation. Ensure timely policy endorsements, addition/deletion of members, and coverage changes. Track claims and coordinate for claim settlements and documentation. 4. Data Management & Reporting: Prepare and manage CD (Claim Details) statements, endorsement summaries, claim trackers, and MIS reports. Create and maintain dashboards for internal and client reporting. Analyze data to identify trends and provide actionable insights. 5. Internal Coordination & Compliance: Coordinate with internal teams for data collection, report generation, and service delivery. Ensure all processes comply with IRDAI regulations and internal quality standards. Qualifications & Skills: Graduate/post-graduate in any discipline (MBA/PGDM preferred). 5-7 years of experience in employee benefits management, with at least 2-3 years in an insurance brokerage setup. Strong understanding of group health insurance, claims process, and TPA functioning. Proficiency in MS Excel, PowerPoint, and dashboard tools. Excellent communication, interpersonal, and problem-solving skills. Ability to handle data-driven discussions with HR and insurance partners.

Urgent requirement for BHMS/BAMS/BDS -Chennai(Annasalai) Freshers/candidate with clinical or TPA experience. Interested candidates can call on 9371762436 or share their updated resumes to career@mdindia.com Job Description: Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Required Candidate profile: BAMS / BHMS / BDS graduate. Male candidate prefer. Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also apply. Work from office. Venue details: MDIndia Health Insurance TPA Pvt. Ltd., Raheja towers, Unit 005, Delta wing no-177, Beside LIC building, Annasalai, Chennai-600002.

Role & responsibilities - Due Diligence - Document Indexing & Management - Sanction Screening - Compliance checks - Premium Bordereaux Processing - Knowledge of insurance systems like Acturis, Applied Epic/Eclipse will be added advantage - Experience in the insurance sector, preferably with brokers or MGAs, will be an added advantage - Familiarity with Lloyds systems integration (XIS, XCS, ICOS/IPOS) is a plus - Updating the process documents - Providing supporting documents during various internal/external audits - Advance excel knowledge Preferred candidate profile Need Fresher or who have experience into claims and settlement Must be fluent with communication

Job Title: Hospital Billing Executive Qualification: Any Graduate Job Type: Full-Time Job Summary: We are seeking a detail-oriented and experienced Billing Executive to join our hospital's finance and accounts team. The ideal candidate will have a strong background in hospital billing processes, insurance claims, and patient account management. Key Responsibilities: Generate accurate inpatient and outpatient bills in accordance with hospital policies. Verify patient insurance details and coordinate with TPA (Third-Party Administrators). Ensure proper documentation for billing, including medical records, investigations, and doctors notes. Process and submit insurance claims within stipulated timelines. Follow up on pending or denied insurance claims and take corrective action. Handle cash, card, and digital payment transactions. Resolve patient billing inquiries and disputes in a professional manner. Maintain daily and monthly billing reports and records. Coordinate with departments like admissions, nursing, and pharmacy to ensure billing accuracy. Comply with all healthcare regulations and hospital guidelines. Required Skills: 34 years of hands-on experience in hospital billing operations. Good understanding of healthcare billing, insurance processes, and TPA procedures. Familiarity with hospital management software (e.g., HIS, Meditech, or similar). Strong numerical and analytical skills. Excellent communication and interpersonal skills. Attention to detail and ability to handle sensitive patient information with confidentiality.

We are looking for candidate with Experience into Brokerage Calculations, Renewals, QuoteSharing , Booking Revenue. Preferred candidate profile Ensure Brokerage is calculated Properly Understanding of Insurance Services Excellent Written and Oral Communications

We are looking for candidate with Employee Data, Premium Calculation , Exp into GPA , GMC, GTA , GTL will be aded advantage. Preferred candidate profile Ensure Brokerage is calculated Properly Understanding of Insurance Services Excellent Written and Oral Communications

Role & responsibilities Ensure team members are visiting the customers place as per the schedule Monitor the team members activity in terms of volumes (documents collected) Review the queries received from the customer and the responses from the team members Help team members in resolving escalationsfrom customers Review the reports sent by the team members and take necessary actions (issues with respect to claim registrations) based on the report. Coordinate with front end team and help in getting the claims registered Conduct weekly/monthly one on one review with the team membersto understand their concerns and help simplify the process Review the claims dump along with front end team and take necessary action for IR raised, reopening the claims, dummy claims as appropriate Review the feedback received from the customers. Rework on the low ratings and identify the areas of improvement and implement process improvements Team management Review on the low C-SAT/D-SAT to improve the communication quality or process gap if any as per the clients understanding/requirement. Coordinate with internal/external stakeholders and other regions on the support needed for the client requirements, like helpdesk , wellness-related activity and more. Preferred candidate profile 3-5 years of experience in people management and customer service & 7-8 years of overall experience in service industry

TATA AIG General Insurance Company Limited is looking for Deputy Manager - Health Claims to join our dynamic team and embark on a rewarding career journey Assist the Manager in the day-to-day operations of the business, including setting goals, developing strategies, and overseeing the work of team members Take on leadership responsibilities as needed, including managing team members and making decisions in the absence of the Manager Identify and address problems or challenges within the business, and develop and implement solutions Collaborate with other departments and teams to ensure smooth and efficient operations Maintain accurate records and documentation Contribute to the development and implementation of business plans and goals

To contact the insured for Underwriting referred proposals to procure the complete medical history using Audio and/or Video tools. To Follow up with customer for past medical records and/or relevant health documents Maintain end to end TAT / SLAs. Required Candidate profile Location – Bangalore Candidate must know to speak excellent English. CTC – Upto 3.5 LPA.