1031 Tpa Jobs - Page 25

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.

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...