407 Tpa Jobs - Page 11

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 in order to improve their Technical & operational capability. Ensure service SOP compliance and quality of service delivery by effective supervision of Team - on the job as per company SOPs Ensure compliance with the contractual obligations of NKA clients are Conduct Pest Audit of NKA and close customer audit non-conformities Ensure the Operations Team completes Pest audit as per iCABs/contract agreement using rAuditor, and closes customer audit non-conformities (external / internal) Conduct daily & weekly review meeting of OEs/AOM and monthly operations meeting with Technicians Approval of conveyance amount for all the AOMs Ensure customer complaints are attended within 24 hours & resolved with reduction in escalation. In case any of the Operations colleagues are on leave or position is vacant, should ensure entries are made in iCABS to achieve operations KPI of Branch. Advance Operations Succession planning: Ensure availability of qualified Technician, OEs, SP, AOM as per branch business plan to meet new sales as per sales forecast. Ensure SHE golden rule, PN, SRA and ATEX compliance in the Branch. Monitor and maintain material consumption, Overtime Hrs. as per Branchs AOP target OM to monitor and ensure daily chemical consumptions are updated in NAV by respective team members and before month closing confirm Physical stock and NAV stock are matching. Maintaining Optimum Stock Level and Ensuring Indents are raised after checking requirement and stock. Track, Monitor and ensure input costs at all major sites as per gross margin agreed & implement action plans to bring it within limits in Branch Actively drive Service & Product Leads and ensure Branchs AOP targets are met Surprise visits to KA and NKA to ensure compliance with the contractual agreement and support Technicians and OEs Analyse service complaints, prepare action plan, guide OEs/AOMs to ensure AOP targets are met Inventory: analyse material consumption and optimise consumption- prepare action plan, guide OEs/AOMs to ensure AOP targets are met Ensure strict implementation of Service SOPs, SHE golden rules, SRA, PN and use of Approved Preparations List products. Identify & resolve Service delivery issues in coordination with the Branch Manager Provide technical and operational support to OEs and AOM Ensure termination notifications are attended effectively and promptly. Analyse and take appropriate actions in case of any deviation that could impact service quality or productivity of technicians like- overcommitments, recommendation regarding night service (if it is not needed), covered area mismatch, etc Monitor and drive SOS, service productivity and efficiency Monitor and ensure 100% PMI audits are completed as contract agreement. Monitor Branchs SCP usages and Active devices. Ensure that the usage is always about 95% & active device count is always 100%. Analyses visit extraction notes for all high infestation related service visits on daily basis & take action Ensure that the services of NKA are delivered through the certified technicians & with SCP only. This is MANDATORY Ensure Branch CVC scores as per target and increase in promoters numbers based on resolution of grievances of detractors/passive Visit customers (along with OEs, AOM) and help resolve issues highlighted by customers/OE/AOM. Ensure the team adheres to the safety guidelines and conducts SRAs as per the set process Coach and motivate Technician by route riding through OE/OM for quality service Lead generation. Also guide how to conduct techno commercial audit by analysing the suitable need at the customers site. Key Result Areas: ToS improvement- 60-75% (as per branch AoP target) Manpower Management: 100% availability of qualified Technician, planner, OEs and AOM as per business plan Delivered MTD SOS >95% and Technicians productivity - R/FTE, Visit/FTE as per branch AOP targets Complaint management: Ensure reduction in Call Outs and increase CVC score as per AOP targets Manage material consumption with improved Branch monitoring and Optimise the material consumption by implementing innovation as per branch AOP targets. 100% TPA and Development plan based Technicians grading Ensure 100% usage of SCP devices & all devices are active throughout the year in respective branch Deliver budgeted Service Leads and encourage & motivate technicians to submit the Service Leads as per AOP target Retain & grow existing customers to improve Customer Retention as per AOP target 100% PMI target as per iCABs are achieved of the branch as per contract agreements myR Usage for customer reviews, trend analysis & going paperless Self learning and development- Above 90% score in online assessment. Deliver agreed SHE Plan- LTAR Target | WDLR Target Educational Qualification / Other Requirement: Minimum B. Sc. (Chemistry / Zoology / Agriculture) 3-4 yrs of experience in operations of pest management or service industry is desirable Profi

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com 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 unique needs of each market segment.Claim processing team collects end-end data dataDevelop and deliver business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for Ability to establish strong client relationshipAbility to handle disputesAbility to manage multiple stakeholdersAbility to meet deadlinesAbility to perform under pressure- Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation

Roles and Responsibilities Manage billing processes for hospitals, ensuring accurate and timely submission of claims to TPAs and insurance companies. Oversee medical billing operations, including claims processing, cash posting, and denial management. Develop and implement effective strategies to reduce claim rejections and improve revenue cycle management (RCM). Collaborate with healthcare providers to ensure compliance with NABH standards and regulations. Analyze financial data to identify trends and areas for improvement in hospital administration. Desired Candidate Profile More than 18 years of experience in medical billing (hospital administration). Degree in Hospital Administration or relevant discipline; MBA/PGDM- Finance is preferred. Strong knowledge of billing procedures, claims processing, cash posting, denial management, health care services, medical billing, NABH guidelines. * Interested candidate can share their CV at ayesha.tabassum@iqct.in

* Good knowledge about TPA. * Must have handled Insurance Pre Authorise and final billing enhancement. * Preparing daily report. * Daily patient visit. * Willing to do COVID duty.Roles and Responsibilities Candidate Profile Any Graduate with 1 - 4 years of experience in Hospital insurance -Pleasant Personality with good communication skills. -Interested candidates please forward your resume to Whatsapp number 7299052617

Manage and maintain the hospital's computer systems, ensuring seamless operation of data entry, patient records management, and IT support. This role is critical for maintaining accurate documentation and efficient communication within the hospital

About Rentokil PCI Rentokil PCI is the leading pest control service provider in India. A Rentokil Initial brand, Rentokil PCI was formed in 2017 through a joint venture (JV) between Pest Control India, the number one pest control company in India, and Rentokil, the world s leading pest control brand. Rentokil PCI aims to set new standards for customer service having operations across 300 locations in India. About the Role: OE / Sr. OE shall be owner of his / her assigned service areas within the Branch in terms of operations related actions as given in job responsibilities, and shall be responsible for providing qualified Technicians for execution of services. Responsible for Resi, SA, SMEs. Job Responsibilities: A. Core Operations Ensure availability of qualified (trained & certified) Technicians at all time as per Technical Training Guidelines. Coach and train assigned technicians in order to improve the service quality and customer retention of the assigned service area, as per Technical Training Guidelines & service SOPs. Ensure availability of recommended preparation, materials, and service tools in working condition to Technicians as per service SOPs Conduct daily 10 min stand up meeting, and explain safety and special instruction to assigned technicians to execute the job as per instructions received from Sales Team/Service Docket. Ensure SCP devices are effectively used by technicians, troubleshooting of SCP issues and providing refresher training to technicians on the updates as & when required. Ensure all On-Site service documentation in Partner Kit are up to date as per contractual requirements and as per myRentokil (for myR customer) Ensure implementation and Compliance of service SOP, SHE golden rules, ATEX and PINK NOTE by self and the assigned technicians . Minimum 15 customer visits per week that includes- Surprise visits, Rout ride, TPA, Customer complaints, Pest Audits, etc.- Resi & SA (including QSRs) Ensure APL (Approved Preparations List) listed preparations, products and materials are used in line with service SOPs Ensure material stores are maintained appropriately as per good storage practice and disposal of empty containers, used TG/Control board, pesticides wrappers and damaged materials are disposed in line with SOP Ensure proper schedule of maintenance & repairs of equipment is established & is followed periodically In case any of the Operations colleagues are on leave or position is vacant, should ensure entries are made in iCABS to achieve operations KPI of Branch. Ensure technicians carry out treatment within a given Standard Treatment Time (STT) in a competent manner and effectively follow the route plan and timings defined by Service Planner. Approval of conveyance amount for assigned technicians Promote highest grooming standards (uniform, Safety shoes, PPEs) B. Advance Operations Conduct PMI Pest Audit as per icabs- QSRs & Small branch accounts Plan & execute 01 TPAs (Technicians Performance Assessment) per assigned technician with 1 development programs per year. Identify & resolve Service delivery issues in coordination with the Branch Manager Ensure customer complaints are resolved as per complaint management SOP and update the Root Cause in iCABS to ensure proper ticket closure in time. Analyse customer complaints- CO- service wise and improve skills of identified Technicians to reduce CO & ensure closure by monitoring open tickets on weekly basis Compliance and closure of audits non-conformities w.r.t. service operations (Internal / External) Track and optimize material consumption as per SRF, Cost sheet and SOW and report deviations to line manager Ensure adequate stocks of materials as pending & new jobs in line with APL and SOPs are available in branch, and near expiry materials are used first. Track and monitor materials consumption to ensure branch material consumption within the target. Maintaining Optimum Stock Level and Ensuring Indents are raised after checking requirement and stock. Monitor and drive service productivity and efficiency. Carry out Pest Management Inspection- Pest Audits of assigned customers as per iCAB using rAuditor Ensure Service leads are submitted by all technicians as per the target Monitor & report to Line Manager on input costs at all major sites as per gross margin agreed & discuss action plans to bring it within limits. Actively drive Service & Product Leads for assigned technician group within service area by on the job coaching to create density of customers. Encourage technicians to plan their leaves in advance to curb absenteeism Help Resolve any Grievances & IR issues of Technicians & bring to the notice of the Line Manager on day to day basis Report any deviation that could impact service quality or productivity of technicians like over commitments, recommendation regarding night service, additional visits, covered area mismatch, etc. Self Development- Be updated with latest innovations, Service SOPs, SHE and PN updates. Key Result Areas: 100% completion of PMI Pest Audit as per icabs- QSRs & Small branch accounts Material consumption target to be met 100% as per Branch AoP target TPA and Development plan

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 dona.antony@mediassist.in or WhatsApp to 9632777628

tpa

Role :Relationship Manager Skill-Good Communication skill with Healthtech&healthcare domain Location:Chennai Company:ViFin Industry: Fintech -Hospital Claim Settlement Process&Insurance Affordability Experince 1+years Contact 9962442924/7825845773

Hiring Alert Medical Officer (Claims) | Contract Role Location: IBC KNOWLEDGE PARK, Bhavani Nagar, S.G. Palya, Bengaluru, Karnataka 560029 Company: Medi Assist Insurance TPA Private Limited CTC: 3.4 LPA Timing: 9:30 AM 6:00 PM | MonFri (Rotational Saturdays working) Duration: 12-month contract (with chance of contract extension/on-roll conversion) Eligibility: BAMS or BHMS graduates only 0–3 years experience (freshers welcome!) Role Overview: You will scrutinize and process insurance claims based on policy terms, verify treatment/diagnosis, raise queries for incomplete documents, and ensure accurate and timely closure of claims. Key Skills: Strong medical understanding Basic computer & typing skills Good communication Send your resume to: pavana.praveen@mediassist.in prathiba.b@mediassist.in

We have two openings. One for our MUMBAI office and other for NAGPUR office. Role & responsibilities This role involves executing the companys insurance strategy and ensuring tasks are completed within stipulated time. Actively manage the insurance portfolio to ensure right mitigation methods are adopted to safeguard companys assets & interest. Actively co-ordinate and be involved to fulfil the requirements during the pre-tendering stage. Ensure implementation of the adequate insurance requirement with the projects involved and follow the insurance procurement process. Coordinate with various departments to implement insurance process and strategy. Follow-up with relevant stake holders to obtain information required to update insurance policies. Follow insurance claims process to have efficient & fair settlement within reasonable time. Collate and provide the requisite documents for claim processing. • Implement the insurance & risk mitigation process to achieve overall objective of the company. Liaison with the insurance intermediaries, insurers, TPAs for day to day task. Prepare and maintain proper records of insurance policies & renewals, publish various trackers & MIS for discussion. Ethical conduct and maintain highest ethical standard. Preferred candidate profile Graduate / Post-graduate with 4 - 10 years of experience in General Insurance, Insurance products, coverage options & insurance trends Good understanding on insurance / claims requirements Ability to assess and quantify Good negotiation skills Strong communication skills - English language fluency Analytical skills Proficient ability in Computers, Microsoft Word, Excel, Powerpoint Presentations and project/supply chain management software, if any

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com 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 unique needs of each market segment.Claim processing team collects end-end data dataDevelop and deliver business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for Ability to establish strong client relationshipAbility to handle disputesAbility to manage multiple stakeholdersAbility to meet deadlinesAbility to perform under pressureNA Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation

We are pleased to announce a walk-in interview for the role of Sales Executive & Operations Executive at Rentokil PCI , a leading organization committed to delivering excellence. Are you passionate about sales and looking for . Preference will be given to local candidates from Guwahati for ease of commuting. Candidates willing to relocate from nearby areas of Guwahati are also welcome to apply for this roles. Immediate joiners or candidates with a short notice period will be given preference. Experience: 0 to 5 years ( Graduate freshers are also welcome ). Qualification: Any graduate, preferably B.Sc. (Chemistry / Zoology / Agriculture). Valid driving license and two-wheeler are mandatory. Important Instructions: Carry your updated resume. Review the Job Description (JD) and visit the company website before the interview. Dress in formal attire for the interview. Competencies (Skills essential to the role): Good Interpersonal & Networking Skills Ability to communicate effectively Ability to negotiate with the clients Abi

Responsibilities: * Manage clinic operations & staff * Oversee patient care & treatment plans * Conduct PAIENT counseling sessions * Monitor TPA & insurance claims * Ensure compliance with ECHS standards Accessible workspace

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 a 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 respond to mails accordingly. Interested Candidates can share their resumes to disha.raman@mediassist.in or WhatsApp on 8904968911

Shubham Hospitals, Varanasi is looking for Medical Officer Senior to join our dynamic team and embark on a rewarding career journey. Diagnosing and treating patients' illnesses and injuries. Creating and maintaining patient medical records. Prescribing medication and therapies. Ordering and interpreting diagnostic tests. Referring patients to specialists as needed. Developing and implementing treatment plans. Educating patients about their health conditions and treatment options. Working closely with patients and their families, as well as other healthcare professionals.

TPA / Health Insurance Exp. is preferred Assessment of Health Claims Assessment of Treatment & Medication given in the papers sent for claim Cost optimization Approval of Claims for Processing MBBS , BHMS & BAMS Doctors only

Role & responsibilities To give Claims & Cashless/preauthorization, and scrutiny Medical Reimbursement Claims, and to Process Claims Third Party Administration (Health) services (TPA) Claims and Preauthorization Processing HealthCare Assistance Services High Ratio Claims Management in coordination with Networking and Empanelment Department Monitoring the overall operations of Claims and Preauthorization. Responsible for ensuring efficient response at the level of Preauthorization to maintain TAT. Ensure adherence to processes and controls. Creating the process for claim processing (Cashless and Reimbursement). Co-ordination between Network Hospitals/Preauthorization/Claims. Ensuring a high-quality patient care at customized/optimized cost. Creating the process for claim processing (Cashless and Reimbursement). Preferred candidate profile • Good Excellent oral and written communication, negotiation, and decision-making skills. • Good customer service/relationship skills and ability to work effectively in a fast-paced environment with shifting priorities . Must be willing to work in non - clinic TPA EXPERIENCE mandatory. Clinical Exp.

Role & responsibilities To give Claims & Cashless/preauthorization, and scrutiny Medical Reimbursement Claims, and to Process Claims Third Party Administration (Health) services (TPA) Claims and Preauthorization Processing HealthCare Assistance Services High Ratio Claims Management in coordination with Networking and Empanelment Department Monitoring the overall operations of Claims and Preauthorization. Responsible for ensuring efficient response at the level of Preauthorization to maintain TAT. Ensure adherence to processes and controls. Creating the process for claim processing (Cashless and Reimbursement). Co-ordination between Network Hospitals/Preauthorization/Claims. Ensuring a high-quality patient care at customized/optimized cost. Creating the process for claim processing (Cashless and Reimbursement). Preferred candidate profile • Good Excellent oral and written communication, negotiation, and decision-making skills. • Good customer service/relationship skills and ability to work effectively in a fast-paced environment with shifting priorities . Must be willing to work in non - clinic TPA EXPERIENCE mandatory.Clinical Exp.

Responsibilities: * Lead claims processing from intake to resolution. * Ensure compliance with regulatory requirements. * Optimize processes, reduce TAT & improve SLA. * Manage team performance and development. Annual bonus

Role & responsibilities Responsible for managing client relationships with key decision makers Subject matter expert for partners and internal staff for the assigned product Addresses the gaps identified between client requirement & the service provided Ensure that the service is delivered in accordance with the agreed service level agreement Act as a point of contact for any escalation or feedback from clients Collaborate with the other functional Group to evaluate the product performance and to recommend Refinements and improvements in service performance Establish and maintain on-going partner relationships and anticipate and resolve potential problems of the client Manage account renewal, customer support escalation Ensure smooth support during renewal of account Excellent Communication Skills Good knowledge of MS Office Open to travel

Manage Risk Investigation for Controlling Mortality and reduction in Crude Death Rate Identify patterns of Sales Malpractices and work with Linkages to facilitate field Will be primary responsible for the coordination and handling of investigation agencies that carry out field verifications on behalf of Max Life. Monitoring and controlling the work done by the Risk verification agencies regularly. Ensure that the quality of the reports submitted by the agency is good. Identify new agencies for conducting verifications. Create effective MIS/ database of all investigations/cases handled Develops fraud investigation and fraud reporting standards and procedures, monitors compliance, and contributes to quality improvements and the improvement of fraud risk management practices and policies. To effectively conduct the regular activities of the UW risk management Unit & minimize fraud losses & carry out effective risk management with Due Diligence. Meet the requirements of Anti-Fraud & Risk management department goals. Measures of Success Reduction of fraud incidence Incidence of fraudulent death claim drop Desired qualification and experience Graduate/Post Graduate in any discipline preferably in Insurance, Life Sciences, Commerce or medicine. 4+ years experience in Life/Health Insurance/TPA/ other Operations preferably in claims management and processing Should be we'll versed with MS office, particularly MS Excel. Knowledge and skills required High analytical skills Strong on core values of Max Life Strong communication (verbal and written), interpersonal, and influencing skills.

JOB PURPOSE To handle statutory compliances for Bangalore & SSC Hyderabad locations , employee statutory benefit & employee insurance at group level ORGANISATION CHART KEY ACCOUNTABILITIES Accountabilities Key Performance Indicators Employee Insurance (GPA, GTI & GMI) Responsible for end to end insurance renewal process quotations, finalization, payments, policy generation Coordinate with partnered insurance companies, TPA and broking company for day to day operational issues related to endorsements, additions, deletions, corrections, claims, CD statements etc., Coordinate for providing CD statements / CD reconciliations to respective business for their accounting purpose and to obtain CD refund if any upon closure of policy. Statutory compliances To handle and guide on complying with statutory provisions of Labor Laws across the Group. To handle and guide team for monthly remittance of PT, ESI, registrations under Shops & Establishment Act & PT renewals including statutory returns. To Provide support in handling Single PF code across the Group from UAN creation to submission of claims. To handle notices received from various statutory authorities. To handle court cases filed by employees on service matters like termination etc., Trust Administration To handle Gratuity and Superannuation Fund Trusts across the Group including approvals from IT authorities for newly formed Trusts. To liaison with LIC for settlement of Gratuity and Superannuation Settlements. To coordinate with Banks for maintaining of Gratuity and Superannuation Fund Trust accounts. To coordinate with Auditors for preparation of financials every year for all Gratuity and Superannuation Fund Trusts and to ensure filing of Returns with IT authorities Renewing all group insurance policies, Gratuity polices with LIC as on due date Completing monthly statutory remittances (ESI, PF, PT) as per the provisions. Address employee grievances related to Gratuity, SAF, EPF, ESI, Insurance as per the TAT. Settlement of employee claims (EPF, Gratuity, SAF) within the TAT. Completion of Trust audits as per the IT dept. provisions within KEY ACCOUNTABILITIES - Additional Details EXTERNAL INTERACTIONS Govt. EPF, ESI, PT, LIC, Labor departments. Non Govt. Insurance partners, TPA, Broking firm etc., INTERNAL INTERACTIONS Business HR and employees of the Group wherever required FINANCIAL DIMENSIONS OTHER DIMENSIONS EDUCATION QUALIFICATIONS MBA HR RELEVANT EXPERIENCE 9-11 years experience in handling EPF, ESI, Gratuity, Insurance and registrations under shops and establishments act. Should have handled Gratuity / SAF trusts for at least 2-3 years Well versed with Group insurance policy administration and should have 3-5 yrs. experience in handling employee group insurance policies. Work exposure in shared services is added advantage Good Communication Skills Hands on experience in preparing reports in excel and PowerPoint presentations Good stakeholder and vendor management Handling a team size of 3-4 employees. COMPETENCIES Personal Effectiveness Social Awareness Entrepreneurship Problem Solving & Analytical Thinking Planning & Decision Making Capability Building Strategic Orientation Stakeholder Focus Networking Execution & Results Teamwork & Interpersonal influence

Job description URGENT OPENING FOR MEDICAL OFFICER Workings Hours: 9 Hrs Work Mode : Office Key Responsibilities: Review and assess medical claims submitted by corporate clients against policy terms and medical guidelines. Analyze clinical documents such as medical reports, diagnostic tests, prescriptions, discharge summaries, and other relevant medical records. Verify the authenticity, appropriateness, and completeness of medical documentation related to claims. Provide medical expertise to determine the validity and admissibility of claims. Collaborate with claims processing and underwriting teams to resolve discrepancies or clarifications related to medical information. Identify potential fraud, over-utilization, or discrepancies in claims through thorough medical evaluation. Maintain up-to-date knowledge of medical terminologies, treatment protocols, and emerging health trends relevant to claims assessment. Assist in developing and updating medical claim processing guidelines and protocols. Support training and capacity-building activities for claims staff on medical aspects of claims. Ensure compliance with regulatory and company policies during claims assessment. Communicate effectively with healthcare providers, corporate clients, and internal teams to clarify medical information as needed. Generate detailed reports and documentation on claim assessments and decisions. Qualification: BHMS, BMS

To efficiently and effectively handle all IPD Billing related activities like registration and billing for patients to ensure smooth work flow: To be responsible for preparing all IPD bills and keeping its records as per set protocols. To keep yourself updated with information of all payer plans for different panel companies and TPAs. To review the payer plans and codes of different corporate & TPA and to ensure that same is updated in HIS and monitor its implementation also. To be responsible for keeping record for all correspondence done for IPD billing patients. To identify and resolve IPD patients billing complaints and to raise red flag to the concerned authority in case of any difficulty. To ensure accurate and timely submission of all monthly and daily reports. To achieve high level of customer satisfaction at each interaction. To be responsible for maintenance of department records as per the NABH requirement. To be responsible for effective utilization of hospital information system. Should have total familiarity with all instructional manuals and operating procedures applicable to the role and in accordance with NABH protocols. To participate in training programs to maintain and update your professional knowledge. Any other task assigned to you by your HOD from time to time.