694 Tpa Jobs - Page 15

I am hiring for this position for one of our Life Insurance clients. Role & responsibilities Prudent claim Assessment and management of end-to-end claim settlement /repudiations, including Life, Group claims Coordinate with Reinsurers /sales/customers for closure of claims within the regulatory framework and timelines Direct and oversee the maintenance of complete and accurate claim management records. Managing the claim teams on day-to-day claims transactions, guidance on claims philosophy, regulatory, and audit procedures Ensuring daily claim deliverables are met and claims decisions within prescribed SLA with quality Ensure customer centric approach while delivering sensitive area of deat...

Roles and Responsibilities 01. Involves Processing of Claims ( Preauthorization / Reimbursement claims) 02. Validating and processing these claims within TAT 03. With good communication and medical Knowledge 04. TPA Experience is an added advantage Financial : To see to that there is no financial implication for the organization while settlement of claims Role : Medical Officer Required Knowledge /Skill : Clinical / TPA /Medical knowledge with insurance background Education : MBBS Working timing: Morning Shift / General Shift / Afternoon Shift / Evening Shift Job Location : IBC Knowledge Park, 4th Floor, D Block, Dairy Circle, Bannerghatta Road, Bangalore Note : This position is for Working ...

The candidate must have completed BHMS, BAMS, or BUMS from a reputed university." Experience : 0 to 2 years Locations : Bangalore, Chennai and Mumbai / Pune 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 control...

Job Title: Billing Incharge - Hospital Billing & Claims Location: Moradabad Department: Billing Reports To: Hospital Administrator / Finance Manager About Hospital: The Siddh Multispeciality Hospital is established by Dr. Anurag Mehrotra, MD, DM, FACC, FESC a renowned figure in the field of cardiology for last twenty years. We have been able to achieve NABH (Complete) & ISQUA (For International Patients) Accreditations in short span of time. Hospital also got accreditation with NBEMS for DNB courses. Siddh Hospital is tertiary Care hospital known for its cardiac & intensive care. Hospital also excess in equipped departments like gastro surgery, minimal invasive surgery, ortho & neurosurgery,...

The SOC professional will be responsible for the preparation of third party attestation reports, including Service Organization Control (SOC) 1, SOC 2, and WebTrust for CAs, as well as HITRUST, and ISO, applying most areas of the governing standard as necessary and documenting, validating, testing and assessing various control systems. This position may also be involved in other business process or IS assurance related engagements, including SOX, IT general control testing for private company financial audit engagements, and agreed-upon procedure engagements. Job Duties Control Environment Applies knowledge and understanding of the collective effect of various factors on establishing or enha...

About the role : We are looking for a Dedicated Claims Specialist with a strong background in medical and health insurance, particularly in group medical corporate policies . The ideal candidate should have 2-4 years of experience in claims processing or CRM roles. Key Responsibilities: Handle end-to-end processing of reimbursement claims for group medical corporate policies. Provide excellent customer service by addressing claims-related queries via Freshchat, Ozontel, and Freshdesk. Analyze medical documentation, policy terms, and conditions to ensure accurate claim assessment and processing. Liaise with internal teams, insurers, TPA s, and hospitals to ensure seamless claims settlement an...

About the role : We are looking for a Dedicated Claims Specialist with a strong background in medical and health insurance, particularly in group medical corporate policies . The ideal candidate should have 2-4 years of experience in claims processing or CRM roles. Key Responsibilities: Handle end-to-end processing of reimbursement claims for group medical corporate policies. Provide excellent customer service by addressing claims-related queries via Freshchat, Ozontel, and Freshdesk. Analyze medical documentation, policy terms, and conditions to ensure accurate claim assessment and processing. Liaise with internal teams, insurers, TPA s, and hospitals to ensure seamless claims settlement an...

Key Roles & Responsibility : Planning and supervising changes and managing the daily operations of customer service. Setting up and meeting performance goals and targets. Maintaining current knowledge of industry new developments, productions, and involvement in network. Recording statistics, performance levels and feedback of clients and preparing the reports. Motivating, coaching, and retaining staff as well as coordinating reward, bonus, and incentive scheme. Reviewing the staffs performance, determining training needs and scheduling training sessions. Responsible for the efficient functioning of CRM by ensuring that the Team attends to customer calls & Networking with the concerned depar...

You will be responsible for guiding patients and attendants to various health services provided by the hospital. Your role will involve ensuring that the correct billing is conducted based on the type of service required by the patient. Additionally, you will be assisting patients and attendants by resolving their problems and addressing any queries they may have regarding their case. Your duties will also include directing patients to the appropriate departments within the hospital, maintaining Management Information System (MIS) records, and adhering to Turnaround Time (TAT) requirements. You will be required to escalate any grievances to the designated officer and deliver reports to the p...

Looking for doctors who have experience in processing Cashless And Reimbursment Claims (Group or Retail) Experience - 2+ years in claim processing

Prepare final bill when cash/TPA/corporate/fund cards come for discharge. In the case of TPA credit patients, if the bill exceeds the approval final bill with discharge summary is send it to the insurance dept for the final approval. If there is any collection to be done from patient it is done (E.g. co-payment, room restriction, non applicable charges etc). Every day morning all the previous day discharged cards are to be cross checked whether they have paid the bill and show discharge in the HIS. In case of cash patient if they have not paid who has given permission should give a letter which should be attached with the card & it is filed in the billing dept. In case of credit bills after ...

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Claims processing Doctor Job Description: Medical claims processor will have to look into claims where payment was denied. Commonly due to issues of insurance coverage eligibility, the claims handler may be tasked with reviewing documentation from the patient, their physicians, or the insurance. With the medical expertise ,need to master the various products and to apply the same during claim processing. Claims processors process any claim payments when applicable and must ensure they comply with federal, state, and company regulations and policies. List of Responsibilities: To validate the authenticity and the credibility of the claims. To coordinate with various persons (Claimant, Treating...

Role & responsibilities Claims adjudication, claims approval, TAT, accuracy, productivity, claims cost, fraud and leakage control, client/provider feedback, team training and retention Preferred candidate profile Processing claims, quality check and adherence to TAT, fraud triggers, fraud risk assessment, computer skills. Candidate should be open to work in 24X7X365 environment Microsoft office proficiency Knowledge of Indian Health Care and prior experience in Health Insurance Claim Processing, Good Clinical Acumen Minimum 1-3 Years Preferred Industry Health Insurance/TPA/Hospital / Clinical Practice/heath care/ wellness etc.. Minimum- Medical Graduate (BDS/BAMS/ BHMS/BPT/ BUMS) Preferred L...

Designation-Executive/Team Lead in CRM for Client Servicing for Big Corporate. Job Location: Vadodara (Implant/Helpdesk) 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. Coor...

Key Responsibilities: Conduct induction training for new joiners across all departments. Design and deliver process-specific training modules for Claims Processing, Claims Coordination, and Support Teams. Train internal and external staff on insurance processes, and TPA/Hospital workflows. Monitor and assess trainees performance during and after training; recommend improvements. Maintain accurate training records and prepare training reports for management. Support knowledge sharing, performance improvement, and continuous learning culture across the company. Requirements: Bachelors degree in any discipline (preferred: Healthcare, Management, or related fields). Minimum 2–4 years of experien...

Designation-Team Lead/Assistant Manager in CRM for Client Servicing Job Location: Gurgaon Industry-TPA Company or Health Insurance will only be preferred If you are interested, please you can visit to Office between 11AM to 1PM Monday-Friday Vidal Health TPA | 531-532 | Udyog Vihar | Phase V | Gurgaon | Haryana 122 016 Contact Number-9971006988 Job Description: Key Responsibilities: 1 . Management and Retention of Top corporate for the region alont 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 ...

The Clinton Health Access Initiative, Inc. (CHAI) is a global health organization committed to our mission of saving lives and reducing the burden of disease in low-and middle-income countries. We work at the invitation of governments to support them and the private sector to create and sustain high-quality health systems. At CHAI, our people are our greatest asset, and none of this work would be possible without their talent, time, dedication and passion for our mission and values. We are a highly diverse team of enthusiastic individuals across 40 countries with a broad range of skillsets and life experiences. CHAI is deeply grounded in the countries we work in, with the majority of our sta...

We are seeking a dynamic and result-oriented Marketing & Sales Specialist for our 200 bedded NABH accrediated hospital.The candidate will be responsible for driving referral sales, managing relationships with empaneled organizations. Required Candidate profile To achieve monthly and annual revenue targets. To devise monthly and yearly plans & review the progress. To develop good relationships with senior corporate contacts to drive business growth.

Identify, approach, & onboard hospitals & clinics for cashless treatment & financing solutions Promote Medical Loans (0% EMI) and Advance Against Mediclaim to hospital partner Coordinate with internal teams for smooth activation & issue resolution Required Candidate profile Hospital onboarding, TPA coordination, healthcare sales, or medical loans HealthTech, NBFC, insurance, or hospital B2B sales Self-starter, target-oriented, and willing to travel locally

Roles and Responsibilities Candidate has to do TPA Empanelment. Candidate will handle entire billing part and documentation. TPA/Cashless /ECHS /CGHS /ESIC billing & documentation. Liaison with Govt. Health Departments. Liaison with Insurance Companies. Tie ups with Corporate Houses. Must be aware of norms of insurance sector. Desired Candidate Profile Good communication. Must have good command over MS Office. Candidate must have experienced in Third party/ Empanelment Corporate tie-ups. Must have experienced of Hospital. Must have Experienced TPA/Cashless/ECHS/CGHS processors. Perks and Benefits Performance based Incentives Interested candidates may share their cv on WhatsApp 8875029935 wit...

Role & Responsibilities Handling TPA related all process from billing to co-ordinate with TPA companies. Responsible for counseling patient's family & pre-Auth process. Maintaining & uploading patient's files on the portal. Couriering the hard copy of patient's medical file to the Insurance companies. Responsible for all co-ordination activities from patient's admission to discharge. Handling billing Department, Implants bill updating & reconciliation. Daily co-ordination with the patient and Hospital staff. Outstanding follow-up with TPA. To obtain and review referrals and authorizations for treatments. Must be aware of norms of the insurance sector. Daily follow up with Insurance companies...

POSITION: MEDICAL OFFICER PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Mumbai/Bangalore Educational Qualification Shift BHMS, , BAMS, MBBS(Indian registration Required) Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check the medical a...

POSITION: MEDICAL OFFICER PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Medical Officer Claims PA/RI Approver Reporting to Location Assistant Manager Claims Noida Educational Qualification BHMS, , BAMS Shift Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check the medical admissibility of a claim by confirming the diagnosis and treatment d...

POSITION: MEDICAL OFFICER/CONSULTANT PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Chennai Educational Qualification Shift BHMS, , BAMS , BDS, B.Sc Nursing. Rotational Shift (for female employee shift ends at 7:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check the medical admissibility ...