705 Tpa Jobs - Page 26

Role: Closed file review & audit 1-Handling closed / open file review for third party administrator & inhouse claims 2-Recoveries from third party administrator for claims processed with errors 3-Highlight areas of improvement 4-Monthly reports to be published Candidate must have: 1-In-depth knowledge of medical cases with exposure to ailment treatments, policy coverages for OPD/hospitalization/personal accident/ travel claims 2-Good interpersonal skills 3-Must be proactive & effective learner 4- Must have previous experience of Audit 5- Good Analytical, Communication and Negotiation skills 6- Familiar with Basic Microsoft Excel and regulatory changes 7- Minimum 7 years of experience in gene...

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years Language - Ability: English(International) - Intermediate 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 envi...

Karthika Consulting & Solutions Pvt Ltd is looking for Medical Officer 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

Role: Team Leader - Account Management (CRM) Job Responsibilities Client Servicing Resolving customer queries within TAT and ensuring smooth claim process Providing information to the customers and to respond to their claim related queries Coordinating with the customers/agents for cashless claim settlement Coordinating with internal stakeholders like enrolment, Account management, claims, investigation, support team to settle claims Transactional Activities To coordinate with inward team for claim receiving and claim registration Allocating new generated claims to processing team for action Liasoning with enrolment team to register the policy for cashless and reimbursement Coordination with...

Role: Team Leader - Account Management (CRM) Job Responsibilities Client Servicing Resolving customer queries within TAT and ensuring smooth claim process Providing information to the customers and to respond to their claim related queries Coordinating with the customers/agents for cashless claim settlement Coordinating with internal stakeholders like enrolment, Account management, claims, investigation, support team to settle claims Transactional Activities To coordinate with inward team for claim receiving and claim registration Allocating new generated claims to processing team for action Liasoning with enrolment team to register the policy for cashless and reimbursement Coordination with...

The Claims Adjuster manages claims being submitted by TA field locations concerning general liability, auto liability and property claims. This position plays a critical role in collecting evidence/facts, investigating claim allegations, reviewing damages, determining liability, and negotiating with claimants. What you will deliver: 1. Review code and assign claims to diaries as needed. 2. Act as a point of contact for field in investigation and examine and investigate details of claim. 3. Determine required reserves and place on claims in accordance with the delegation of authority. 4. Corresponds with claimant and witnesses, also consult with police, hospital records, and with other expert...

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 and timely resoluti...

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 and timely resoluti...

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 and timely resoluti...

About Tech Mahindra Foundation (TMF): TMF is the corporate social responsibility arm of Tech Mahindra Limited, a Mahindra Group Company. Since 2006, the Foundation has been working tirelessly in the areas of education, employability, and disability with a keen focus on corporate volunteering. To know more about our SMART Academies, please visit: https://www.smart-academy.in/careers/ To know more about the organization, please visit: www.techmahindrafoundation.org At TMF, we believe our team members are the heartbeat of our organization. We foster a vibrant and inclusive workplace where every individual is cherished, respected, and empowered to thrive. We're on the lookout for an exceptional ...

Urgent requirement for BHMS/BAMS/BDS/MBBS-Pune (Vadgaonsheri) Freshers/candidate with clinical or TPA experience Interested candidates can call on 7391042258 (Sneha- HR department) or share their updated resumes to recruitment@mdindia.com Roles and 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. Required Candidate profile: BAMS / BHMS / BDS/ MBBS graduate. Good Medical & basic computer knowledge Should have completed internship (Provisional /Permanent Registratio...

We are Hiring for Assistant Manager HR (Recruitment & Talent Acquisition) Only male candidates required Urgent requirement forAssistant Manager HR (Recruitment & Talent Acquisition) interested candidates can call on 9371762436 Roles and Responsibilities Manage bulk hiring campaigns for healthcare clients, ensuring timely delivery of high-quality candidates. Collaborate with internal teams to ensure seamless onboarding process for new hires. Desired Candidate Profile 1-2 years of experience as Assistant manager(Recruitment & Talent Acquisition) in bulk hiring, mass hiring, or volume hiring. Proven track record of success in managing large-scale recruitment projects within tight deadlines. Str...

Skill required: Retirement Solutions - Customer Service Designation: Customer Service Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years What would you do? 1+ years of experience in US Retirement Services domain – Defined Contributions – Managing Institutional contributions/ payroll contributions Alternatively, 1+ years experience in payroll processing (preferred) Remittance file management, Incoming contribution management, Payroll file management, Suspense resolution, Client communication (email and phone), Lockbox management Process incoming contributions for assigned clients\transactions. Includes;oManual formatting nonstandard payroll files received (large data),...

Skill required: Retirement Solutions - Customer Service Designation: Customer Service Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 years What would you do? " 4+ years of experience in US Retirement Services domain – Defined Contributions – Managing Institutional contributions/ payroll contributions Alternatively, 3+ years experience in payroll processing (preferred) Remittance file management, Incoming contribution management, Payroll file management, Suspense resolution, Client communication (email and phone), Lockbox management Process incoming contributions for assigned clients\transactions. Includes;oManual formatting nonstandard payroll files received (large data),...

TPA Liaison: Serve as the primary point of contact between the hospital and TPAs, ensuring smooth claims processing and reimbursement. Collaborate with TPAs to verify patient eligibility, approve pre-authorizations, and facilitate smooth discharge procedures. Ensure timely submission of claims, follow up on outstanding claims, and resolve any discrepancies or issues related to TPA reimbursements. Corporate Client Coordination: Act as a liaison for corporate clients, addressing their queries and ensuring employees medical needs are met efficiently. Coordinate with corporate clients to manage employee health programs, including corporate insurance policies, wellness programs, and preventive he...

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

Post: Billing Sr. Executive/ Executive, OPD/IPD Billing, Patient Care Executive, Front Office Executive Hospital Name: Batra Heart & Multispeciality Hospital, Sector-31, Faridabad Qualification: Graduation Experience: Minimum 2 Years of Experience (Hospital / Healthcare Experience is Must) Gender : Male/Female Interview Time: 11am to 4pm Candidates can attend walking interview at the hospital location at Batra Heart and Multispeciality Hospital, spring Filed Colony, Sector 31, Faridabad. Or send their CV at hr@batrahealthcare.com (with Current Salary & expected salary) Job Description: Preparing final billing during patient discharge Responsible for patient admission & IPD Billing, Patient I...

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

Immediate job openings for Doctor's with Star Health & Allied Insurance No. of open positions: 20 nos. Location: Royapettah, Chennai Job description Honour the clients and ready to provide the best consultation Handling customer queries and clarifying claims related Ensure safekeeping of the client records Responsible for handling problem of the clients in a highly professional manner Experience in Medi-claims processing Qualification: BDS / BAMS / BHMS / BSMS / MBBS / MDS / BPT / NMD Experience: Fresher / Experienced in handling TPA medical claims Languages to be known: Tamil / English / Hindi Contact details: HR Sangeetha Email Sangeetha.karthik@starinsurance.in Interested candidates walk-...

Investigate health insurance claims, verify medical records, detect fraud, conduct field visits, and prepare detailed reports. Coordinate with hospitals and ensure compliance with TPA policies and IRDAI guidelines. Medical background preferred.

Role & responsibilities To go through the bill and counselling on the approximate cost of the treatment in consensus with the treating consultant. To give the interim bill update day to day and explain the details of the bill and signature of the same need to be done. Ensure that the payment is done post counselling according to the bill amount and treatment procedures. Ensure transparency in billing. Keep a track on the TATs defined and adhered to the same Maintain good interpersonal relationships with Doctors , Patients , Corporate Representatives and other departments Preferred candidate profile Candidate should have Any degree qualification. Candidate should have min 1 year Hospital Indu...

l To Audit daily allotted cases as per Target l To compare the audit remarks received from the claims team l To maintain quality while doing the audit l To co ordinate with the provider network team and account managers or internal teams for additional Information about claims,tariff etc. l To complete the Audit finding to a Logical end l To share the responses to the insurer within the TAT. To assess the RCA for the errors and suggest the resolutions to avoid future audit

Job Summary To register new patients under TPA, attend queries, pre-authorization of request, claims, bill recovery. Job Responsibilities Handling all debtor receivables, Solving all queries, which are related to bill. Checking all IP files before dispatch. Checking the reasons of cancellation of bill, free bill, discount bill, refund bill. Preauthorization request will be sent to the respective scheme office for the approval of the concerned treatment (surgical / medical) Making the changes of packages rates/tests rates as per the Company Agreement. Maintaining the Debtors aging report for OP & IP All the inpatient bills will be sent for the claims to the respective scheme office. Communica...

Role: Senior Executive - Account Management 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. NOTE: Must have TPA or Insurance work experience for min 1-2 yrs

Role: Senior Executive - Account Management 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. NOTE: Must have TPA or Insurance work experience for min 1-2 yrs