1024 Tpa Jobs - Page 10

JD Account Management- Senior Executive Job Responsibilities: Client Servicing Receive and check claim documents for completeness and advice employees regarding pending documents, if any. Track and control documents to ensure TAT of claims/cards as per SLA. Feedback from Insurers and Corporates. Additional revenue opportunities from existing Corporates. Respond to queries from the employees of the corporate through e-mails. Maintain weekly reports on claims and queries and the TAT of the same Escalate issues as per the escalation matrix. To attend to any other assignments assigned to you from time to time. Respond to queries from the employees of the corporate over Phone Maintain weekly repo...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model t...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

Manage MJPJAY desk operations, handle approvals, documentation, and claims, counsel patients on benefits, liaise with TPA/insurance, generate reports, and ensure smooth hospital workflow under scheme guidelines.

Role & responsibilities Coordinate with healthcare providers, insurance companies, and patients to resolve claims-related issues. Process patient claims from admission to discharge, ensuring accurate billing and payment processing. Manage TPA (Third Party Administrator) operations, including CRM (Customer Relationship Management) systems. Handle customer queries related to medical insurance policies, claims status updates, and reimbursement procedures. Maintain accurate records of all interactions with customers and stakeholders. Job Requirements : Strong understanding of health insurance products, medical terminology, and regulations governing TPAs. Proficiency in using CRM software for man...

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 d...

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 d...

Role & responsibilities To go through the bill and counselling on the approximate cost of the treatment in consensus with the treating consultant. To give the interim bill update day to day and explain the details of the bill and signature of the same need to be done. Ensure that the payment is done post counselling according to the bill amount and treatment procedures. Ensure transparency in billing. Keep a track on the TATs defined and adhered to the same Maintain good interpersonal relationships with Doctors , Patients , Corporate Representatives and other departments Preferred candidate profile Candidate should have min degree qualification. Candidate should have min 1 year Hospital Indu...

Secondary Skill : Serving with Integrity & CouragePosition Specific duties : Manage the ongoing medical, life and accident insurance for all geographies stay in connect with all stakeholders, ensure service levels and drive improvement Conduct analysis and study along with insurance broker for sourcing the right partner well before renewal time Create ongoing data-driven insights relating to insurance claims to drive speed, efficiency and cost improvement in claims and claims processing. Create dashboards and review with stakeholders periodically Drive cost reduction in claims through TPA, insurers and focusing on overall well-being of employees and families Ensure all systems and processes ...

Role & responsibilities Assess and process health insurance claims as per policy terms Preferred candidate profile Must have a degree in BDS, BHMS, or BAMS.

MUST HAVE SKILLSETS IN PROFILE: Solution Architect Presales- RFP/RFI Data Centre, Storage, Service desk Managed Services Must have worked on Onsite customers Handled team & also willing for Individual Contributor role IT Infrastructure Job Description: The role is part of the Cognizant s Cloud, Infrastructure and Security (CIS) Services BU Solution Group, which involves supporting proactive and reactive business opportunities of solutions around Infrastructure in the space of Managed Services & Transformation etc across all verticals. The individual will be closely working with onsite sales, solutions and delivery teams, and participate in solution discussions, workshops, due diligence etc. ...

Responsibilities: * Coordinate with hospitals & insurers * Manage TPA operations from start to finish * Maintain compliance with ESIC regulations * Ensure timely claim settlements * Process medical claims efficiently Annual bonus

TPAs, insurance companies, and corporate clients Pre-authorization and final approval process TPA desk operations Claims submission Discharge processes TPA tariff rates

Position: Billing Executive Experience: 2 years (Minimum), 5 years (Relevant/Additional) Additional Exp.: Handling TPA portals, insurance coding, pre-authorization processes, and billing in a hospital setting. Proficiency in Hospital Information Systems. Experience of using Tally. Location: Dahej Skills: Communication, negotiation, documentation, persuasive ability, target orientation, strong interpersonal skills, listening and achievement orientation Qualification: Graduate (B.Com) with knowledge of TPA operations and hospital billing Language preferred: English, Hindi, Gujarati To manage accurate patient billing, prepare estimates, process insurance claims, and coordinate with TPAs to ensu...

This role is responsible for developing and maintaining strong relationships with strategic clients, driving revenue growth, and ensuring customer satisfaction. This role requires a blend of strategic planning, business development, and operational execution to optimize customer value and long-term partnerships. The ideal candidate should have a strong background in account management, client servicing, and business expansion within a fast-paced, customer-centric environment. Key Responsibilities: Develop and execute a strategic account plan for key clients to maximize revenue and customer satisfaction Identify and capitalize on growth opportunities within existing accounts Act as the primar...

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 d...

Role & responsibilities Short Paid Claim Contesting Executive-Drive timely and accurate contesting of short-paid claims across hospital-insurer interfaces, ensuring recovery yield and SOP compliance. Analyze short-paid claims and categorize by deduction type, insurer, and RCA triggers. Draft and submit contest letters with supporting documentation via IHX and insurer portals. Track contesting outcomes and escalate unresolved cases per SLA timelines. Collaborate with unit credit cells and central recovery team for RCA discipline and documentation hygiene. Maintain dashboards for contesting status, win-loss ratios, and financial impact. Ensure adherence to SOPs and flag deviation trends for go...

Role & responsibilities Maximize recovery of outstanding claims from TPAs and insurers through disciplined follow-up, documentation, and stakeholder coordination. Monitor aging reports and follow up on pending claims across TPAs and insurers. Coordinate with internal billing, credit cell, and finance teams for claim documentation and query resolution. Engage with insurer/TPA representatives to expedite settlements and resolve disputes. Maintain tracker for recovery status, escalations, and financial realization. Support RCA documentation and contesting for short-paid or denied claims. Prepare weekly MIS and recovery dashboards for leadership review. Preferred candidate profile Familiarity wi...

About The Role Skill required: Retirement Solutions - Data Entry Services Designation: Customer Service Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the...

About The Role Skill required: Retirement Solutions - Data Entry Services Designation: Customer Service Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the u...

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 admissibil...

About The Role Skill required: Retirement Solutions - Data Entry Services Designation: Customer Service Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the u...

About The Role Skill required: Retirement Solutions - Data Entry Services Designation: Customer Service Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the u...