5 Reimbursement Claims Jobs

Reimbursement Claims: To review claim documents received from customer/insured Identify Risk assessment & maintain TAT. Manage Data. Cashless Claims: Preauthorization claim, Manage TAT, Quality adjudication . Required Candidate profile Degree – BHMS/BDS/BPT/BAMS. Exp. – 1+ yrs. in any TPA/Insurance company in Cashless Claims or Reimbursement Claims.

The role of Medical Officer involves processing preauthorization and reimbursement claims, ensuring validation and processing within the specified Turnaround Time (TAT). It requires strong communication skills, medical knowledge, and familiarity with Third Party Administrator (TPA) processes. Experience in TPA handling is considered an advantage for this role. One of the key responsibilities is to manage claims settlement efficiently to prevent any financial implications for the organization. The ideal candidate should possess knowledge and skills in clinical practices, TPA procedures, and medical aspects with a background in insurance. The educational qualification required for this role includes a degree in BDS, BHMS, BAMS, BYNS, or BUMS. The working hours are in the general shift from 9:30 a.m. to 6:30 p.m. with a hybrid mode of working. This hybrid model includes three days working from the office and three days working from home. The job location for this position is in Sector 91, Mohali, or Sector 25, Chandigarh. It is essential to note that this role is for working from the office only. Candidates who are looking for remote work and immediate joining are advised not to apply. This is a full-time position with a day shift schedule. As part of the application process, candidates will be asked questions regarding their willingness for a hybrid mode of working and acceptance of the offered salary range. The work location is strictly in person.,

JOB PURPOSE This position extends critical support in terms of handing, monitoring Chairman-Airports (CA) mails swiftly with shortest turnaround time, escalate the mails to BCMO Business Team for their inputs & check with Head-Integration for his directions on important / confidential matters before escalating to BCM. Follow up with BCM for mails reply, directions & approvals. To process hard copy of Financial approval notes, MOM & Board Resolution documents for BCMs signature, coordinating pre-read materials from various department and forwarded to BCM before the meeting, etc. Planning and execution of travel details of Chairman Airports including itinerary, flight, visa, accommodation, etc. Provides fall back support to BCM-A in secretarial functions including scheduling of meetings, travel in the absence of Secretary. To provide efficient assistance to the respective GHB members in the areas ofadministrative activities, Travel, accommodation, meeting, events for GHB Members (promoters) in Mumbai location, Data management & support respective teams for smooth functioning of daily tasks and enhance manager productivity. KEY ACCOUNTABILITIES Key Performance Indicators Office Management: Scrutinize mails, effective calendar management, fixing appointments, review meetings, prioritizing phone calls, maintaining accurate contact database, general filing and maintain to do list. Effective time management Travel Management: Coordinate travel logistics for local, outstation & overseas visits i.e. tickets, hotel booking, visas, insurance, forex, matrix, logistics, coordinating itinerary, checklist, etc.TimelinesExpense Management: Prepare and submit reimbursement claims based on the expenses incurred adhering to policy and within timelines e.g. Travel, Mobile, Petrol, Medical etc., tracking reimbursements Accuracy of MISData Management: Collation of discussion material, compiling MIS, assistance to prepare Presentations for conferences/seminars/review meetings, updation of address book, support Manager in the role of EA.Accuracy and timelineVisitor Management: Facilitate in-office and external meetings, ensuring hospitality, booking venue, logistics, coordinating schedule, follow up pending meetings list, etc.Ensuring timelines Endorsements: Approve leaves, team reimbursement claims, accounts related car form, purchase orders in SAP in line with policy, ensuring timely submission of HR relatedinitiatives e.g. goal sheets, annual / mid- year appraisals, financial competency of team, etc.TimelinesTeam Support: Provide all assistance and coordination to respective teams , assist Manager for any personal work, support Superiors as and when requiredTimelines

Role & responsibilities A) Claims 1. ZOCAs shall be the main link between Zonal team and the HO Claims and will coordinate in such a way that the Claims resolutions are made quicker and creates customer satisfaction. 2. Track claims from intimation to payments of money in the claimants accounts. Attend to the full lifecycle of the claim. 3. Any bottlenecks in upload of claims, either from office, customers portal, agents Portal, agents Virtual Office , Star Health App or physical hand over of documents to Office, to be reported & addressed. 4. Handle any bottlenecks in payment like non-availability of NEFT / Payee / Nominee details 5. ZOCA shall be responsible for speedy & accurate delivery of claims to the Customers of the Zone. However, the position will not have any claims settlement authority, unless specifically given. 6. Shall be responsible for the quality & efficiency of uploading / ROD/ Billing at Zonal levels. 7. Shall attend to the complaints from agents and other marketing personnel, check the status of the claims, inform them about it, coordinate with Corporate team on any delayed claims, follow up coordinator/ query requirements etc . For this they shall use the Escalation matrix already laid down. 8. For issues in cashless claims they shall be in touch with Claims processing Drs 9. Work as an Early Warning system to avoid any bottlenecks that may be getting developed at local levels. This could be spread of local contagious infections like Dengue, resignation of critical personnel, hospitals over charging claimants etc. 10. Inform to Corporate Claims, areas which may bring in high claims ratios like identified Agents / SMs/ Branch Offices to take preventive measures 11. Coordination with Zonal Grievance coordinators for speedy resolution of grievances related to claims. 12. Checking and confirming that various SMS / E mails from Claims dept are reaching the target customers by looking at random samples. 13. Shall check the efficacy of IT systems and if any deficiencies are noted at ground levels, suggestions may be provided to HO Claims. 14. They shall popularize the usage of Star Health App among customers and VO / Atom app among Agents and SMs 15. Ensure that the reimbursement claims of OPD & Preventive Health Care ( PHC) & Pre approval Tests are settled at Zonal Office quickly and efficiently Fraud Mitigation 1. ZOCAs to keep a watch out for any fraudulent activities going in any Hospitals, groups of agents, SMs which could lead to Fraudulent claims 2. Keep an alert on High ICR Branches for any tendencies on fraud within employees. 3. Provide necessary support to FVR/ Vigilance officer / Fraud investigator B) Hospital related (to work in coordination With Regional HRM Head & HRMs) 1. Issues faced by Hospitals in connecting to the Cash less team, getting pre Auth & auth and also uploading of bills in SPP or Vitreya portals. 2. Shall also coordinate with Zonal HRM team to ensure that the Zone has very effective and large Network of hospital 3. Take up with Hospitals to reply to the letters written by CHAIR / Triage seeking explanations. Coordinate with HRMs to arrange VCs with the Hospital as required by CHAIR VC team 4. Arrange TPA desk training frequently and submit reports to HO. 5. Coordinating with Hospitals to get the correct identity of Director of medical services, treating Drs etc for corporate claims to negotiate with the Hospital 6. Coordinating with HRMs / Hospital for PCC operations 7. Please bring to the attention of Claims team if any Hospital continuously bad mouths us. 8. Bring to the attention of EPPM/ Claims if it is known that our network Hospitals charges us more than other health insurers. C) Administration 1. Overseeing the functions & performance of the Claims team reporting to you. The expected roles of Zonal Claims Coordinators 2. Zonal Claims Head shall oversee, guide, train and develop the functions of Zonal Claims coordinators. 3. Discipline to be maintained in the Claims team. This including the attendance, approved leaves, WFH to be clearly approved etc. 4. Check on actual tours, geo tagging facilities extended etc. 5. Organize reviews of High ICR branches with the help of Commands. 6. Shall ensure that the claims team has adequate resources at all times. ZOCA also shall follow up with Training Academy and Zonal trainers to provide continuous training to the claims team. 7. Arranging/ coordinating delivery of training to agents / marketing team on new developments on claims side, in coordination with Zonal Trainers. 8. To submit biweekly reports to Corporate Office on all activities in the specified formats. 9. To keep Corporate Claims informed about any matters which may endanger services to customers, aggravation of losses or negative image in the market. 10. Any other function or role requested from Corporate Office from time to time. D) Reporting ZOCAs will report to Regional / Zonal Head (depending on the office in which he / she reports) who will be L1 and Command Head will be L2.

Role & responsibilities A) Claims 1. ZOCAs shall be the main link between Zonal team and the HO Claims and will coordinate in such a way that the Claims resolutions are made quicker and creates customer satisfaction. 2. Track claims from intimation to payments of money in the claimants accounts. Attend to the full lifecycle of the claim. 3. Any bottlenecks in upload of claims, either from office, customers portal, agents Portal, agents Virtual Office , Star Health App or physical hand over of documents to Office, to be reported & addressed. 4. Handle any bottlenecks in payment like non-availability of NEFT / Payee / Nominee details 5. ZOCA shall be responsible for speedy & accurate delivery of claims to the Customers of the Zone. However, the position will not have any claims settlement authority, unless specifically given. 6. Shall be responsible for the quality & efficiency of uploading / ROD/ Billing at Zonal levels. 7. Shall attend to the complaints from agents and other marketing personnel, check the status of the claims, inform them about it, coordinate with Corporate team on any delayed claims, follow up coordinator/ query requirements etc . For this they shall use the Escalation matrix already laid down. 8. For issues in cashless claims they shall be in touch with Claims processing Drs 9. Work as an Early Warning system to avoid any bottlenecks that may be getting developed at local levels. This could be spread of local contagious infections like Dengue, resignation of critical personnel, hospitals over charging claimants etc. 10. Inform to Corporate Claims, areas which may bring in high claims ratios like identified Agents / SMs/ Branch Offices to take preventive measures 11. Coordination with Zonal Grievance coordinators for speedy resolution of grievances related to claims. 12. Checking and confirming that various SMS / E mails from Claims dept are reaching the target customers by looking at random samples. 13. Shall check the efficacy of IT systems and if any deficiencies are noted at ground levels, suggestions may be provided to HO Claims. 14. They shall popularize the usage of Star Health App among customers and VO / Atom app among Agents and SMs 15. Ensure that the reimbursement claims of OPD & Preventive Health Care ( PHC) & Pre approval Tests are settled at Zonal Office quickly and efficiently Fraud Mitigation 1. ZOCAs to keep a watch out for any fraudulent activities going in any Hospitals, groups of agents, SMs which could lead to Fraudulent claims 2. Keep an alert on High ICR Branches for any tendencies on fraud within employees. 3. Provide necessary support to FVR/ Vigilance officer / Fraud investigator B) Hospital related (to work in coordination With Regional HRM Head & HRMs) 1. Issues faced by Hospitals in connecting to the Cash less team, getting pre Auth & auth and also uploading of bills in SPP or Vitreya portals. 2. Shall also coordinate with Zonal HRM team to ensure that the Zone has very effective and large Network of hospital 3. Take up with Hospitals to reply to the letters written by CHAIR / Triage seeking explanations. Coordinate with HRMs to arrange VCs with the Hospital as required by CHAIR VC team 4. Arrange TPA desk training frequently and submit reports to HO. 5. Coordinating with Hospitals to get the correct identity of Director of medical services, treating Drs etc for corporate claims to negotiate with the Hospital 6. Coordinating with HRMs / Hospital for PCC operations 7. Please bring to the attention of Claims team if any Hospital continuously bad mouths us. 8. Bring to the attention of EPPM/ Claims if it is known that our network Hospitals charges us more than other health insurers. C) Administration 1. Overseeing the functions & performance of the Claims team reporting to you. The expected roles of Zonal Claims Coordinators 2. Zonal Claims Head shall oversee, guide, train and develop the functions of Zonal Claims coordinators. 3. Discipline to be maintained in the Claims team. This including the attendance, approved leaves, WFH to be clearly approved etc. 4. Check on actual tours, geo tagging facilities extended etc. 5. Organize reviews of High ICR branches with the help of Commands. 6. Shall ensure that the claims team has adequate resources at all times. ZOCA also shall follow up with Training Academy and Zonal trainers to provide continuous training to the claims team. 7. Arranging/ coordinating delivery of training to agents / marketing team on new developments on claims side, in coordination with Zonal Trainers. 8. To submit biweekly reports to Corporate Office on all activities in the specified formats. 9. To keep Corporate Claims informed about any matters which may endanger services to customers, aggravation of losses or negative image in the market. 10. Any other function or role requested from Corporate Office from time to time. D) Reporting ZOCAs will report to Regional / Zonal Head (depending on the office in which he / she reports) who will be L1 and Command Head will be L2.