694 Tpa Jobs - Page 11

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. Client Servicing Responsible for developing the corporate customer base for MDIndia Health Insurance Services. Map the territory and maintain a strong pipeline of potential customers. Establish Contacts with key persons at the corporate and understand the current levels of Health Insurance services and needs. Develop strong relationship with Insurance Co...

Job title :- AM - IPD Billing & TPA (Deduction Recovery) To Manage the TPA/Insurance Agreement and tariff updation and coordinate with TPA Insurance for payment follow up along with max internal team as well for day-to-day work. Role & responsibilities To ensure customers TPA outstanding recovery within defined timelines. Achievement of assigned collection Targets. To maintain Insurance Tracker and updating of case status in E Prapti on weekly basis. Recovery of Top up deduction cases. TPA status of Outstanding cases prior to 30 days (Inclusive of Less than Rs. 10000). Bill docket receiving status prior to 30 days (Real time status basis on TPA records). Outstanding details to be shared with...

Designation-Executive/Team Lead in CRM for Client Servicing for Big Corporate. Job Location: Gurgaon, Haryana Industry-TPA Company or Health Insurance will only be preferred Job Description: Key Responsibilities: 1 . Management and Retention of Top corporate for the region along with Team as a L1 Level. 2. Reports on top corporate/insurance companies/brokers to be reviewed with Leadership Team and proactively act on issues before escalations. 3. Fulfilment of SLAs. 4. Oversee timely submission of MIS reports to Insurance Companies/Corporate etc.. 5.. Oversee department functions like the Customer Care, Claims, Preauth and related functions. 6.Claims and Cashless settlement 7. Coordination wi...

About 2070 Health 2070Health is Indias premier Venture Studio, pioneering an innovation platform dedicated to building groundbreaking healthcare companies from the ground up. Our mission is to identify and seize disruptive opportunities within the healthcare sector. What sets us apart from conventional venture capital and accelerator models is our active involvement in idea generation, day-to-day operations, and strategic decision-making, all geared toward fostering the growth of each newly established enterprise. Additionally, we are proud to have the steadfast support of W Health Ventures. About Everhope Oncology Everhope Oncology is on a mission to transform cancer care by making high-qua...

Role & responsibilities An IP Billing professional, whether an executive or staff member, is primarily responsible for managing and processing billing activities related to intellectual property (IP) or inpatient (IP) services . This involves maintaining accurate records, generating invoices, ensuring timely payments, and handling billing inquiries. They also play a crucial role in ensuring compliance with relevant regulations and collaborating with other teams, such as finance and legal, to streamline processes. Preferred candidate profile A strong candidate for an IP billing role, particularly within a hospital setting, should possess a blend of financial and administrative skills, along w...

You will be responsible for processing claims, including preauthorization and reimbursement claims, in a timely manner. Your role will involve validating and processing these claims within the specified turnaround time. It is essential to possess good communication skills and medical knowledge for this position. Previous experience with Third Party Administrators (TPA) will be considered an advantage. Your primary financial responsibility will be to ensure that the organization incurs no financial implications during the settlement of claims. As a Medical Officer, you are required to have a strong foundation in clinical, TPA, and medical knowledge with an insurance background. The minimum ed...

Walk-in Drive For Clinical Doctors at Cotiviti, Mohali Walkin Date : 31st July & 1st August 2025 Walkin Timing: 9:00AM TO 1:00 PM Interview Address: SANDAL SUITES, Assotech Business Cresterra, 22, Noida-Greater Noida Expy, INFOSPACE, Sector 135, Noida, Uttar Pradesh 201301 Eligibility Criteria: Education: BHMS, BAMS, BPT, BUMS, MPT, MBBS Candidates with prior US Healthcare or Clinical exp will be preferred. (Freshers/Candidates with 1-3 Years of exp) Good team player with strong interpersonal skills and high integrity. Should be ready to work in rotational shifts including night shifts. Should be ready to work from office. Job Location: Mohali, Punjab

About Rentokil PCI About the Role: The Operations Manager shall be responsible for the entire Operations of the Branch and will manage all the operations colleagues directly (Technicians, Service Planners, OE, AOM). The JD lists down duties and responsibilities of Operations Manager to be positioned in Large Branches. The incumbent will report to the Branch Manager and will have to work as part of a multi-functional team and this involves collaboration with the internal team and external stakeholders. Job Responsibilities: Core Operations Ensure only qualified (trained & certified) and competent manpower (Technicians, OE, planner) are assigned jobs & deployed at site. Coach & train OEs & AOM...

You would be responsible for managing the end-to-end claims process for clients, ensuring seamless handling from claim intimation to settlement follow-ups. You will be the key point of contact for clients and AMCs regarding claim processes. You should be strategic and detail-oriented, ensuring timely documentation, filing, and resolution of claims while also contributing to business growth through lead generation and upselling. Requirements You have a bachelors degree in administration, commerce, or a related field. 2-3 years of hands-on experience in insurance claims processing. Ability to communicate correctly and clearly with all customers. Maintain a positive attitude with a focus on cus...

Hiring for the position of Executive CRM (Corporate Relationship Management) Job Description 1. Responsible for developing the corporate customer base for MDIndia Health Insurance Services. 2. Map the territory and maintain a strong pipeline of potential customers. 3. Establish Contacts with key persons at the corporate and understand the current levels of Health Insurance services and needs. 4. Develop strong relationship with Insurance Companies/Brokers. 5. Promptly attending Emails, Phone calls, Whats App messages of Clients. 6. Maintain proper MIS & Internal reports and present it to the management. 7. Ability to work independently, achieve targets and be absolutely result oriented. Skil...

JD Coordinate with teams & hospitals on reconciliations Prepare monthly MIS reports Reconcile payments Manage reconciliation process from start to finish Must know about Government panels like ,Government railways and Ayushman Bharat Provident fund Annual bonus

Vidal is hiring for claim Processor Designation: Executive-Claims Location: Gurgaon, Key Responsibilities: Review and validate claim documents submitted by hospitals or insured members Scrutinize medical records and bills for completeness and accuracy Apply policy terms, conditions, and exclusions to adjudicate claims Perform ICD and procedure coding as per ailment and treatment Coordinate with medical officers for clinical opinion when required Maintain claim logs and update CRM systems with claim status Ensure adherence to defined SLAs and minimize processing errors Flag suspicious or potentially fraudulent claims for investigation Communicate with stakeholders for clarifications or missin...

Role & responsibilities: Outline the day-to-day responsibilities for this role. Preferred candidate profile: Specify required role expertise, previous job experience, or relevant certifications.

Job Title: Operations - Investigations Job Role : Team Leader Minimum Mandatory Qualification : Graduate Experience :2-5 Years of experience in investigation Mandatory Skill : Computer Operations, Computer proficiency, MS Excel, Communication in English & Hindi, Open to work in shifts. Brief Job : Generic job profile includes document processing, data entry process, maintaining trackers, escalate issues as required within organization and follow up to ensure timely resolution . Profile Desired Competencies/ Skill Set : Working knowledge of MS Excel with data entry speed and accuracy, ability to communicate in English and Hindi effectively, Insurance / Health Insurance Knowledge. Should be op...

Job Title: Operations - Investigations Job Role : Team Leader Minimum Mandatory Qualification : Graduate Experience :2-5 Years of experience in investigation Mandatory Skill : Computer Operations, Computer proficiency, MS Excel, Communication in English & Hindi, Open to work in shifts. Brief Job : Generic job profile includes document processing, data entry process, maintaining trackers, escalate issues as required within organization and follow up to ensure timely resolution . Profile Desired Competencies/ Skill Set : Working knowledge of MS Excel with data entry speed and accuracy, ability to communicate in English and Hindi effectively, Insurance / Health Insurance Knowledge. Should be op...

Job Title: Operations - Investigations Job Role : Team Leader Minimum Mandatory Qualification : Graduate Experience :2-5 Years of experience in investigation Mandatory Skill : Computer Operations, Computer proficiency, MS Excel, Communication in English & Hindi, Open to work in shifts. Brief Job : Generic job profile includes document processing, data entry process, maintaining trackers, escalate issues as required within organization and follow up to ensure timely resolution . Profile Desired Competencies/ Skill Set : Working knowledge of MS Excel with data entry speed and accuracy, ability to communicate in English and Hindi effectively, Insurance / Health Insurance Knowledge. Should be op...

Job Title: Operations - Investigations Job Role : Team Leader Minimum Mandatory Qualification : Graduate Experience :2-5 Years of experience in investigation Mandatory Skill : Computer Operations, Computer proficiency, MS Excel, Communication in English & Hindi, Open to work in shifts. Brief Job : Generic job profile includes document processing, data entry process, maintaining trackers, escalate issues as required within organization and follow up to ensure timely resolution . Profile Desired Competencies/ Skill Set : Working knowledge of MS Excel with data entry speed and accuracy, ability to communicate in English and Hindi effectively, Insurance / Health Insurance Knowledge. Should be op...

Job Title: Operations - Investigations Job Role : Team Leader Minimum Mandatory Qualification : Graduate Experience :2-5 Years of experience in investigation Mandatory Skill : Computer Operations, Computer proficiency, MS Excel, Communication in English & Hindi, Open to work in shifts. Brief Job : Generic job profile includes document processing, data entry process, maintaining trackers, escalate issues as required within organization and follow up to ensure timely resolution . Profile Desired Competencies/ Skill Set : Working knowledge of MS Excel with data entry speed and accuracy, ability to communicate in English and Hindi effectively, Insurance / Health Insurance Knowledge. Should be op...

Job Title: Operations - Investigations Job Role : Team Leader Minimum Mandatory Qualification : Graduate Experience :2-5 Years of experience in investigation Mandatory Skill : Computer Operations, Computer proficiency, MS Excel, Communication in English & Hindi, Open to work in shifts. Brief Job : Generic job profile includes document processing, data entry process, maintaining trackers, escalate issues as required within organization and follow up to ensure timely resolution . Profile Desired Competencies/ Skill Set : Working knowledge of MS Excel with data entry speed and accuracy, ability to communicate in English and Hindi effectively, Insurance / Health Insurance Knowledge. Should be op...

Operations Executive is responsible to manage assigned Service area & team of minimum 15 technicians to achieve targeted SOS of his territory and Productivity with Quality & timely execution of service as per schedule. By maintaining the required skill of team up to date as per Technical Training Structure of RPCI . The person will report to the Assistant Branch Manager/Branch Manager. The incumbent will have to work as part of a multi-functional team and this involves collaboration with the internal team and external stakeholders. Responsible to achieve targeted SOS, technician s productivity, ToS, material consumption, complaint management, TPA/SQA, customer visits, Absenteeism & OT, Servi...

Responsibilities- 1. You will have the responsibility of taking complete ownership of postpayment cases assigned to you and to ensure smooth customer experience. 2. You will need to connect with the customers (call and e-mail) who havepurchased Insurance products and update them about the further process andpending requirements- collection and verification of all the documents,scheduling medicals, retention, etc 3. You will also work with different stakeholders of various Insurers (likebusiness spoc, medical TPAs, insurer ops, underwriters etc.) to get theallocated cases issued. 4. You will have to achieve monthly issuance targets at less TAT and high FTRrate. 5. You will have to work with I...

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation Minimum Mandatory Skill Set : Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Desired Competencies/ Skill Set : MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, ...

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation Minimum Mandatory Skill Set : Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Desired Competencies/ Skill Set : MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, ...

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation Minimum Mandatory Skill Set : Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Desired Competencies/ Skill Set : MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, ...

Role & responsibilities 1. To maintain & strengthen the existing relations with TPAs/Corporate/PSU’s 2. Signing up with new TPA’s ,Corporate & PSU’s 3. Trouble shooting 4. Arranging activities at corporate & PSU’s by the way of Camps awareness programmes, Poster campaigns, Standard display. 5. Organizing CME’s for corporate doctors 6. Co-ordinate between Clients, Insurance, Helpdesk & Doctors in the system for patients seamless treatment 7. Keeping tab on competitors & their promotional activities.