694 Tpa Jobs - Page 12

Job Description Coordinate with patients, insurance companies, and internal departments for smooth processing of cashless claims. Facilitate timely pre-authorization approvals and ensure all required documents are submitted. Maintain records of all TPA communications and claim documents. Handle queries from patients and their attendants regarding insurance claims. Follow up with TPAs/insurance companies for pending approvals and payments. Reconcile TPA receivables and ensure timely payment posting and recovery. Assist the billing team in preparing final bills for insured patients. Ensure compliance with hospital policies and insurance guidelines. Regularly update TPA software and internal MI...

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 expe...

Hiring for the position of Sr. 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. ...

Role & responsibilities • To be responsible for maintaining TPA Processing of cashless and all post discharge health insurance claims. • To be responsible to maintain overall TAT entry to exit. • TPA query reply and preauthorisation follow up with insurance company / tpa. • Medical scrutiny and medical opinion for health insurance claims. • Efficient in claim adjudication and claim processing. • Maintaining and ensuring Standard Operating Procedures and protocols. • To be responsible for keeping record for all correspondence done for TPA. • Post discharge reconciliation for utilization of claims. • Timely reply to internal TPA complaint portal. • TPA discharge follow up and closure. • Mmaint...

Role: Executive - Account Management (CRM) 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. Non voice coordinator 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. Interested candidates share Cv on ronojoy.bagchi@mediassist.in

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...

Responsibilities and Duties. 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 i...

KEY RESPONSIBILITIES 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 ADDITIONAL SKILLS • Good communication • Familiarity with Computers and interest in learning on the job. ACADEMIC & PROFESSIONAL QUALIFICATIONS • BHMS/BAMS/BDS HR Pratiksha Shitole, Sr.Executive Talent Acquisition, MDIndia Health Insurance TPA Pvt. Ltd. S. No. 46/1, E-space, A-2 Building, 3rd floor, Pune Nagar Road, Vadgaonsheri, Pune 411014. Email Address: hr9@mdindia.com Contact No. 7058036074

Role & responsibilities Review the performance of all the key Pan India accounts and address the possible areas of improvement to enhance stakeholder satisfaction. Be a team player and leader by periodically reviewing the team's performance, setting goals and targets, and encouraging upskilling for efficient client management. Prepare interim performance reports for these accounts for both the internal and external stakeholders. Organize employee engagement sessions and upskilling for team members through training, coaching and any relevant mentoring sessions. Handle escalations and associated documentation if any. Managing the key stakeholders of the assigned accounts and ensuring their emp...

Job Purpose Procurement of Engineering Materials for Maintenance, Packaging materials for Packaging & Service support for all maintenance activities. Job Context & Major Challenges Job Context: The global aluminum market is valued at USD 87. 84 billion in 2021 and is expected to grow 7. 5 % (CAGR) from 2022 to 2030. Increase in demand for lightweight and durable extruded products is driving the growth. Top aluminum extruders are investing and creating tough competition. Hindalco Industries Limited have acquired the extrusion business of SAPA located at Kuppam, Andhra Pradesh with effect from 01 Feb 2022 through Business Transfer Agreement This plant is first of its kind, across the globe to ...

Job Title: Medical Underwriter (On-site) Location: Gurgaon Duration: Contractual Salary: 60,000 - 75,000 per month Joining: Immediate Job Overview: We are hiring experienced Medical Underwriters for Gurgaon . The ideal candidates will be responsible for evaluating medical risks, reviewing applications, and making underwriting decisions based on medical history and policy guidelines. Key Responsibilities: Assess and underwrite medical insurance applications based on industry standards and company guidelines. Analyze medical reports, diagnostic tests, and case histories to determine risk exposure. Make underwriting decisions based on pre-existing diseases (PED), medical conditions, and other r...

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 ...

Sr. Executive IPD Billing (Night) Kailash Hospital, Jewar KAILASH HOSPITAL, JEWAR (A Unit of Kailash Healthcare Limited) PLOT NO. Manage and oversee end-to-end IPD (In-Patient Department) billing processes, including patient admission, discharge, and final bill generation. Ensure accuracy in billing by verifying patient treatment records, doctor consultations, procedures, investigations, and room charges. Coordinate with clinical and non-clinical departments to collect necessary documents for smooth billing operations. Handle queries related to insurance approvals, TPA documentation, and ensure timely submission and follow-up for payments. Reconcile daily billing transactions and ensure prop...

Urgent opening for TPA Medical Officer/customer service manager profile in Raipur, Rajkot, Kanpur, Baramati, Trivandrum locations. Graduate Medical background, MR (B pharma), BHMS, BAMS/ MBA in Hospital Administration. 2+ Years working experience in health insurance/health insurance TPA at Hospital handling/audit Candidate must have excellent knowledge of health insurance / Health TPA domain. Candidate must have excellent bill/medical negotiation skills & customer handling skills.Good communication skills in Hindi/English and regional language of the state/region .Ready to relocate himself/herself at location within India as may be required according to the job requirement. Candidate must ow...

Urgent opening for TPA Medical Officer/customer service manager profile in Raipur, Rajkot, Kanpur, Baramati, Trivandrum locations. Graduate Medical background, MR (B pharma), BHMS, BAMS/ MBA in Hospital Administration. 2+ Years working experience in health insurance/health insurance TPA at Hospital handling/audit Candidate must have excellent knowledge of health insurance / Health TPA domain. Candidate must have excellent bill/medical negotiation skills & customer handling skills.Good communication skills in Hindi/English and regional language of the state/region .Ready to relocate himself/herself at location within India as may be required according to the job requirement. Candidate must ow...

Candidates with experience in Life/Annuity Insurance product conversion from one admin system to another is very helpful An ideal candidate will require working knowledge to expertise on many of the following: Working daily reconciliation reports and performing root cause analysis for life products (traditional life, universal life, ISWL, Indexed UL). Thorough understanding and experience working with the following product elements: Market Value Adjustment (MVA) Bailout/Caps/Floor rates Free Withdrawal Minimum Gtd Cash Value Premium based bonus (additional X bps credited assuming Prem Paid > Set limit) Account Value based bonus (additional Y bps credited assuming Account Value > Set Limit) M...

Proven experience in leading and delivering life insurance policy conversion projects or similar initiatives. Oversee the entire data conversion lifecycle, from planning and design to execution, testing, and go-live, ensuring projects stay on track and within budget. Work closely with client stakeholders to understand their data requirements, facilitate design sessions, and address their concerns throughout the project lifecycle. Possess a strong understanding of data conversion processes, data structures, and mapping techniques used in life insurance. Manage and mentor a team of data conversion consultants, providing technical guidance, coaching, and performance management. Implement and ma...

Cashless Executive, TPA Executive, Insurance Executive Responsibilities: Patient Eligibility Verification: Claim Processing: Pre-authorization and Approvals: Coordination: Status Tracking and Follow-up: Cashless Admission Facilitation:

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...

Department: Account Management Designation: Account Executive - Team Lead We are hiring an Executive Account Management to build, maintain, and strengthen long-term relationships with clients by understanding their needs, providing tailored solutions, and ensuring high levels of customer satisfaction by acting as the primary point of contact between the client and the organization, ensuring seamless communication, service delivery, and overall account success. Key Responsibility: Respond to employee/corporate customer queries via e-mail/ phone in a timely and professional manner. Coordinate with respective stake holders for cashless claim settlement and resolution . Explain claim decisions, ...

Key Roles : Ensure accurate documentation and timely claim settlement Follow up with TPA and Govt. bodies for approvals/payments Strong knowledge of Govt. healthcare panels (ECHS, CGHS, ESIC, etc.) Experience in hospital billing & claim processing Annual bonus Provident fund Health insurance

Managing CGHS, ECHS, CAPF and Ayushman Bharat Government Portals: Claim Processing Audit Uploading Query Management Reconciliation and Recovery Management. Annual bonus Provident fund Health insurance

TPA Executive to manage pre-authorizations, insurance claims & coordination with TPAs and government health scheme. The role requires accurate documentation, timely claim submissions, & effective communication with internal departments and insurers. Required Candidate profile Graduate with 1–3 years of hospital TPA experience. Proficient in handling CGHS, ECHS, PMJAY claims, insurance coordination, billing & documentation. Strong communication, MS Office & software skills.

Key Responsibilities: TPA & Insurance Networking Build and maintain relationships with TPAs, insurance companies, and corporate health clients. Ensure diagnostic centre is empanelled with major TPAs and insurers. Act as a liaison between the diagnostic lab and insurance companies for service coordination. Sales & Revenue Growth: Drive revenue through insurance-related health check-ups, cashless diagnostic services, and wellness packages. Identify opportunities to increase patient volume through insurance-tied programs. Develop new business from TPAs and corporate clients. Empanelment & Contract Management: Ensure timely renewal and compliance of contracts with insurance companies and TPAs. H...

Greetingd from Niva Bupa! Key Roles & Responsibilities: Answer incoming customer calls in a professional and timely manner. Assist customers with inquiries including medical claims and rejections. Provide accurate and detailed information about claim procedures, documentation requirements, and coverage. Investigate and resolve customer concerns, ensuring high levels of customer satisfaction. Collaborate with internal departments, such as claims processing to address and resolve complex issues. Maintain thorough and up-to-date knowledge of products, medical billing codes, and claim processes. Document customer interactions and update customer records accurately in the system. Identify and esc...