1024 Tpa Jobs - Page 3

Roles & Responsibilities Oversee end-to-end billing operations for OPD, IPD, Emergency, Day Care, Diagnostics, and Surgical cases. Ensure accurate and timely billing as per tariff, package, and doctor orders. Monitor daily billing activities including advances, deposits, interim bills, and discharge finalization. Implement revenue leakage control by ensuring all services, consumables, and investigations are posted. Manage TPA / Insurance / Corporate billing including pre-auth, approvals, final bill submissions, and claim settlements. Coordinate with clinical and support departments (Nursing, Pharmacy, MRD, Front Office, Finance). Maintain compliance with hospital billing policies, audit requ...

As a Billing Auditor at Paras Health, your role will involve reviewing and auditing medical bills to ensure accuracy and compliance with regulations. Your responsibilities will include: - Demonstrating a strong knowledge of medical billing - Auditing IPD patient bills to identify errors - Highlighting deviations to the concerned departments, including Nursing and Billing - Charging missed items in bills - Conducting daily audits of bills and maintaining an error report - Bringing attention to process failures to the management - Performing audits for ECHS/ CGHS/ Cash /TPA bills - Collaborating with other clinical and non-clinical departments for smoother functioning To excel in this role, yo...

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, deductions and provide status updates clearly to customers and agents. Escalate unresolved issues following the defined escalation matrix to get quicker resolutions & communicate the same to the customers. Receive and verify the completeness of claim documents; advise on any pending or missing documents. Coordinate with the inward team for claim registration and ensure proper documentation flow. Allocate claims to the processing team for timely action. Liaise with...

One point of Contact for all Sales heads for representing Medical Process Prior experience in Medical TPA management for Life Insurance sector Must have basic knowledge of Underwriting guidelines & Insurance Operations Establish and Manage relationships with Medical TPAs Good in Handling Operations Team Any new system related changes Vendor Management Regulatory Requirements Internal/External Audit Good in MIS, Reports & Data Analytics Role & responsibilities Monthly Dashboard/Billing Malpractices Risk Management

Medical Officer - Claims Processing Job Title: Medical Officer Claims Processing Location: IBC Knowledge Park, Bangalore (Work from Office) Department: Central Claims Operations Control Room Job Type: Full-time Salary: 3,00,000 3,60,000 per annum About the Role We’re hiring Medical Officers (Claims Processing) for our Control Room team at IBC, Bangalore. The role involves end-to-end medical claim processing with focus on accuracy, coordination, and timely resolution. You’ll work closely with multiple departments to ensure smooth claim operations and compliance with TAT standards. Key Responsibilities Process medical claims accurately within defined timelines. Review and validate claim docume...

Department: Health Claims (Cashless) Location: Hyderabad 1, Indore 1 Reporting To: Chief Manager Health Management Team Key Responsibilities: Claims Assessment: Evaluate and process health insurance claims in accordance with policy terms and conditions. Medical Review: Identify and flag potential cases of medical abuse or discrepancies in treatment protocols. Admissibility Decision: Determine claim eligibility based on thorough review of medical documentation and policy guidelines. Tariff Adjudication: Review and authorize cashless approvals, ensuring alignment with applicable tariffs and negotiated rates. Stakeholder Coordination: Liaise effectively with internal teams, network hospitals, a...

Manager / Assistant Manager Account Management - MediAssist Job Title: Manager / Account Management Company: Medi Assist Location: Bangalore CTC: 9 to 12 LPA Experience: 11 to 15 years Industry: Health Insurance / TPA / Healthcare Key Responsibilities:- Client Relationship & Strategy: Build and maintain long-term partnerships with insurers, corporate clients, and healthcare providers. Lead high-level review meetings and ensure strong relationship governance. Operations & Service Delivery: Oversee end-to-end account operations including claims, customer service, and issue resolution. Ensure compliance with TATs and SLAs. Performance Analysis & Reporting: Monitor KPIs, analyze client data, and...

Manage and oversee billing processes and activities Ensure accurate and timely processing of bills and invoices Monitor and analyze billing performance and identify areas for improvement Ensure compliance with billing regulations and company policies Required Candidate profile Candidate must have prior experience in the healthcare/ banking/ hospitality sector

We are hiring Managerial role in Vidal Health Insurance TPA for Client Servicing (Corporate). Only TPA or Health Insurance industry will be preferred. Immediate Joiner also required. Job Title: Manager Job Location: Gurgaon, Udhyog Vihar Phase 5 Role Objective To lead and optimize the organizations strategy, ensuring seamless client interactions and service delivery across health insurance workflows. Manager will serve as a strategic bridge between technology, client servicing, and operations to enhance customer satisfaction and retention. Key Responsibilities 1.Strategic Corporate Relationship Management 2.Drive retention and satisfaction of top corporate clients across the region. 3.Ensure...

Role: Hospital Desk Executive Hospital Desk Executive will be the Single point of contact at the Hospital for the Medi Assist Raksha Prime Service. Roles and Responsibilities Close Coordination with the Hospitals and the Medi Assist Internal Stake Holders for patients best discharge experience. Collaborate with the operations team to ensure timely and accurate data processing. Ensure maximum discharges are happening through the Raksha Prime Services. Use relevant tools and MIS tools to organize data for reporting purposes. Qualification : Bachelor's/Masters Degree in the field of Pharmaceutical/Hospital Management/Medical Sciences/Insurance (but not Mandatory) Experience: 2-3 Years Experienc...

Role Overview: KR Business Solutions (KR) is a prominent management consulting service provider that offers "requirement-based" services to hospitals and healthcare organizations throughout India. Team KR is dedicated to providing complete healthcare solutions as a third-party administrator (TPA) with a specialized TPA department in a hospital. We offer empanelment consulting, quality accreditations (NABH/NABL/ISO), cashless/reimbursement claim settlement, and hospital planning and development. The company has been established for 16 years and is committed to delivering comprehensive TPA (medical) solutions. Key Responsibilities: - Making outbound calls to potential customers - Answering inc...

Greeting from Medi assist TPA Pvt ltd. Hiring Medical officer for Insurance Claim processing Profile Location- Noida Sector 3 Role - Medical officer Exp : 0-3 years WORK FROM OFFICE ONLY. Job description : 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 ...

Key Responsibilities: Medical Review & Claims Adjudication: Assess and validate medical claims based on clinical documentation and policy coverage. Interpret diagnostic reports, treatment plans, and prescriptions to determine claim eligibility. Coordinate with internal medical teams to ensure accuracy in claims decision-making. Customer Interaction & Support: Communicate with policyholders, hospitals, and third-party administrators (TPAs) to explain claim decisions in a clear and professional manner. Handle escalated or complex customer service issues involving medical claims. Offer support and guidance on claim submission processes and documentation requirements. Compliance & Documentation:...

Department: Health Claims (Cashless) Location: Hyderabad 1, Indore 1 Reporting To: Chief Manager Health Management Team Key Responsibilities: Claims Assessment: Evaluate and process health insurance claims in accordance with policy terms and conditions. Medical Review: Identify and flag potential cases of medical abuse or discrepancies in treatment protocols. Admissibility Decision: Determine claim eligibility based on thorough review of medical documentation and policy guidelines. Tariff Adjudication: Review and authorize cashless approvals, ensuring alignment with applicable tariffs and negotiated rates. Stakeholder Coordination: Liaise effectively with internal teams, network hospitals, a...

Roles and Responsibilities Department: Cashless & TPA Designation: Executive-Cashless & TPA JOB RESPONSIBILITY 1. Need to reach Hospital on Time and cross check the cleanliness of Cashless & TPA room, need to check proper working condition of internet, PC, Printers, Telephone Lines. 2. Should have an updated list of all TPA & Govt PSU on panel with updated MOU & Rate list as per agreed tariff, Email ID with Contact Number of costumer care and TPA Coordinator. 3. Should have proper knowledge of all the documents required for cashless approval, Preauthorization form, claim form and process like RSBY, BSBY, ECSH, CGHS. 4. Should handle entire billing part and documentation. 5. Should fill the a...

Seeking a male candidate with TPA/investigation agency experience, expertise in Mediclaim investigation/verification, team handling, client communication, and TAT management. Focus on reimbursement and cashless claims. Strong leadership required.

Qualification: BDS/ BHMS + MHA Key Responsibilities: * Experience in TPA, Insurance Company, UTI TSL , Hospital Sector * Understanding of the product and provide training and product demo to new and existing clients * Team management/ handing team of Medical officers / quality analysts * Handling operations of the accounts * Meeting and understanding of the customer requirements, plan implementation * Travel to the customer's site as and when required for training and implementing * Ensure service levels are maintained at hospitals * Establish objectives and operational criteria for accounts managed. * Understand the requirements of Clients regularly and implement the process at hospitals. *...

*Overall supervision and functioning of the Department to deal with billing clarifications in respect of various TPA's, Corporate having tie -up with the hospital. Defining IP Packages & Tariff and revising packages from time to time as per decision of the management. *Verification and posting of billable services and generation of bills through the HIS. *Knowledge of ECHS (UTIITSL), ESI (Vidal health). *Assist in generation of MIS Reports. Manager Billing should prepare Monthly Statistics, Monthly Discount, and Revenue and outstanding bills report and forward the same to the HOD/COO. *Co-ordinate with Customers/corporate for billing issues. Obtains revenue by resolving order and invoice dis...

A hospital billing officer's job description includes processing patient and insurance claims, accurately preparing invoices, and managing accounts receivable

manages insurance claims, prepares bills for patients and TPAs, and ensures smooth reimbursement processes for healthcare services. Key duties include handling TPA portals, coordinating with hospital staff and patients, processing claims.

Rolesh & Responsiblity Check the medical admissibility of claim by confirming diagnosis and treatment details Verify the required documents for processing claims and raise an information request in case of an insufficiency Approve or deny claims as per T&C within TAT Note : Work from office.. Thanks Hariprasad

As a Billing Head in the Hospital Industry at Areekode, you will be responsible for overseeing and managing all billing operations. Your role will involve supervising inpatient, outpatient, and insurance billing processes to ensure accuracy and compliance. You will coordinate with departments to resolve billing discrepancies and monitor revenue cycle performance to minimize claim rejections. Managing the billing team's performance, training, and scheduling will also be part of your key responsibilities. Additionally, you will prepare daily/monthly billing and revenue reports for management review. Key Responsibilities: - Supervise inpatient, outpatient, and insurance billing processes. - Ens...

Roles and Responsibilities Manage billing processes, ensuring accurate and timely invoicing to clients. Oversee TPA (Third Party Administrator) operations, including claims processing and settlements. Develop and implement effective revenue management strategies to maximize revenue growth. Collaborate with internal teams to resolve customer complaints and improve overall client satisfaction. Ensure compliance with regulatory requirements related to health insurance industry.

Looking for Immediate joiner Location : Kharghar

health insurance context primarily managesclaims processingclient servicing, and coordination with insurers and hospitals, while an AyushmanMitra is a frontline rolein theAyushman Bharat scheme, responsibleforidentifying andverifying beneficiaries,