406 Tpa Jobs - Page 4

Role & responsibilities Preferred candidate profile

About the Role: The Associate Field Biologist/Field Biologist/Sr. Field Biologist shall be responsible for Pest Audits of Branch Large / HD Customers (having Third-party Audits- USFDA, AIB, BRC, FSSC, SQF, LEED, etc), Key national customers in various segments - Food & Pharma Mfg, w/h, Large food retailers (excluding QSRs, Fast food chains), Large ITES & MA s, etc. The incumbent will report administratively to the DM & functionally to Opex QA and work as a part of the multi-functional team involving collaboration with the internal & external stakeholders. Job Responsibilities: Carry out Pest Audits of Global accounts, Key designated NK accounts- Food & Pharma units, Food & Pharma warehouses, Large food retailers (excluding QSRs, Fast food chains), Large ITES & MA and Branch accounts - Large HD accounts (Third party Audits- AIB, BRC, FSSC, SQF, LEED, etc.). Specific accounts will be assigned at the time of induction in consultation with BM, DM and OpEx. Responsible for proper, on time completion & submission of all audits with reports as per contract agreement of assigned customers by visiting customer sites due as per iCABs calendar plan at an agreed frequency. Share completed audits with customers and internally for actions within 24 hours, after completion of audit inspection. Support, and guide branch operation team to streamline documentation at Global, NK & LA customer sites assigned. Must Generate service leads based on recommendations during audits. Conduct TPA for technicians handling Global, NK & Branch-HD & LA assigned. Conduct surprise visits at NKA & HD accounts as and when required. Identify key improvement areas of site technicians during an audit, encourage and groom them for better performance in service Leads from the customer sites. Must have a complete understanding of Service Operation i.e. technician, supervisor and admin activity. A clear understanding of various Food standards and SOPs, Pink Notes, Standard Forms, SHE, Atex L 2 and other regulations. Be able to Identify Atex atmospheres during audits and report to Opex/ SHE Know and understand pest identification, especially for uncommon pests; Know and understand about life cycle, classification, morphology, and habitat of uncommon pests. Key Result Areas: 100% Audit completion as per iCABS PMI Frequency for assigned accounts At least one (01) service lead per audited site through the recommendations. 100% TPA & development of assigned technicians handling accounts site Meeting NKA customers and developing relations Promote Heat & Co2 Treatment Competencies (Skills essential to the role): Skills in various PMS, sound knowledge of pest & pest management options (ERDM principle) SHE and SCP operating knowledge Good team player with the ability to c

Management of master fees files. Management & control of fees booking entries in accounting software Tally. Controlling billing/invoicing across the country. Arrangements of TPA Service Charge Reports. Coordination with all outstation offices. Fees collection follow-up for early release of payment. Resolving queries from Insurance Companies regarding fees. Resolving system issues at Insurance Companies. Lower TPA fees rate confirmations & follow-ups with Insurance Companies and inter-departments. Liaising with officials of Insurance Companies for early settlement of fees and other queries. Reconciliation of pending fees in books of accounts. Fees MIS management required by Insurance Companies. Audit compliance of Insurance Companies. Compliance of internal & statutory auditors within the company.

Hiring for Assistant Manager for Vidal Health Insurance TPA Pvt Ltd Job Title : CRM Assistant Manager Location: Gurgaon Industry : Health Insurance / Third Party Administration Role Objective To lead and optimize the organizations CRM strategy, ensuring seamless client interactions, data integrity, and service delivery across health insurance workflows. The CRM Manager acts as a bridge between technology, client servicing, and operational teams to enhance customer satisfaction and retention. Key Responsibilities Functional Area RM Strategy & Execution - Design and implement CRM strategies aligned with business goals - Drive customer engagement, retention, and satisfaction initiatives Client Data Management - Ensure accurate and secure client data entry and maintenance - Monitor data quality, segmentation, and compliance with IRDAI norms System Optimization - Oversee CRM platform performance - Coordinate with IT for upgrades, integrations, and troubleshooting Cross-Functional Collaboration - Work closely with Claims, Preauth, Customer Care, and Enrollment teams - Align CRM workflows with service delivery and escalation protocols Reporting & Analytics - Generate dashboards and reports on client interactions, SLAs, and service metrics - Analyze trends to identify service gaps and improvement areas Training & Adoption - Train internal teams on CRM usage and best practices - Promote CRM adoption across departments for consistent client experience Stakeholder Engagement - Coordinate with brokers, insurers, and corporate clients for feedback and service alignment - Support renewal cycles and client onboarding through CRM tools. Skills & Competencies Strong understanding of health insurance and TPA operations Proficiency in CRM platforms and data analytics tools Excellent communication and stakeholder management skills Strategic thinking with a customer-first mindset Ability to lead cross-functional initiatives and drive adoption Experience Required 3-7years in CRM management, client servicing, or operations within the TPA or Health Insurance domain Prior experience in handling enterprise clients and managing CRM implementations is preferred. Interested Candidate can connect -09971006988

Urgent requirement for Assistant MIS Manager (Pune) TPA experience. Interested candidates can call on 9371762436 or share their updated resumes to career@mdindia.com Job Description: Roles and Responsibilities Manage MIS operations, ensuring accurate and timely reporting of health insurance claims data. Develop and maintain advanced Excel models for data analysis, including pivot tables, HLOOKUPs, and VLOOKUPs. Create management reports using TPA's software to track key performance indicators (KPIs) such as claim processing times, denial rates, etc. Collaborate with internal stakeholders to identify business requirements and develop solutions that meet their needs. Ensure compliance with regulatory requirements by maintaining accurate records and adhering to industry standards. Desired Candidate Profile 2-3 years of experience within the TPA Industry Advanced proficiency in Microsoft Excel, including expertise in creating complex formulas like HLOOKUPs, VLOOKUPs, Pivot Tables. Strong understanding of Health Insurance concepts and regulations; knowledge of TPA processes preferred. Ability to work independently with minimal supervision; strong analytical skills required.

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 Mumbai 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 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. • • • Responsibilities Understand the process difference between 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 terms and conditions within the TAT. • Handle escalations and responding to mails accordingly. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies

As a diligent individual within the role, you will be responsible for verifying TPA documents before submission. It will be essential to maintain accurate records of all TPA cases, including approvals and rejections, to facilitate audits and follow-up procedures effectively. Effective communication with insurance companies and TPA coordinators will be crucial in addressing queries and ensuring all necessary information is provided. Furthermore, you will play a key role in preparing and submitting final discharge summaries, bills, and other essential documents required for claim settlement. Monitoring the approval status and handling enhancement requests will also be part of your responsibilities. This full-time position requires a Bachelor's degree, with previous experience in TPA for at least 1 year being preferred. The work location for this role is in person, and the application deadline is set for 17/07/2025.,

Manage insurer & client coordination, handle policies, endorsements, and claims, resolve escalations, build strong broker/client relations, lead servicing team, ensure seamless delivery & represent company in insurer meetings. Provident fund

Role & responsibilities Graduate Medical background, MR (B pharma), BHMS, BAMS/ MBA in Hospital Adminstration 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 own vehicle to travel in various hospital assigned to him Candidate must be computer literate and shall possess skills including but not limited to Microsoft Office Suite and navigating through internet Portals Candidate will be mapped with minimum 20 hospitals for physical visit based on the location and city. Additionally 20-25 Hospitals for Case Audit and Management Proficient in handling complex situations and customers. Candidate must possess clinical knowledge for evaluation of medical files Sound knowledge of surgical procedures and disease cure management Preferred candidate profile

Job Description Acts as an interface between the TPA, Insurance Company and the hospital. Responsible for investigation of suspicious claims. Effective usage of Fraud control measures. Act as a backend support to the TPA. Responsible for data mining and analytics related to Fraud and Investigation (IFD) Field visit for investigation purpose. Open to travel. Desired Candidates Profile Qualification Any Graduate Experience Fresher - 2 Years Exp. Profile Executive If interested kindly share your resume to recruitment1@mdindia.com

This position is responsible for providing administrative support to colleagues in the Talent & Culture function to ensure the timely and accurate delivery of Talent & Culture initiatives and projects. Process day-to-day Talent & Culture administration in an accurate and timely manner Conduct regular file audit for candidate files. Prepare new ambassador s personal files including all necessary forms, document and information. End to End process of Pre-Employment Medicals/Food Handlers renewal test and report administration Ensure that Health and safety policies of ESIC, Group Medical Coverage, Group Personal Accident and Group Term Life Insurance are periodically reviewed and renewed Assist employees in claim process in co-ordination with TPA/ESIC Authorities for ESIC, Group Medical Coverage, Group Personal Accident and Group Term Life Insurance are periodically reviewed and renewed Assist new employees with all the mandatory documentation that is required for completion upon commencement, ensuring all forms are complete. Ensure all the New Joiners background checks, medical check-up done well in time and reports properly documented in the employee file. Prepare various letters and communication to employees Prepare monthly employee newsletter and publish it creatievly Organize and execute engagement & CSR activities Update and track annual and probation period appraisals of all employees Maintain good working relations with all departments and all professional external contacts. Minimum 1 year of experience in a similar capacity Excellent reading, writing and oral proficiency in English language Proficient in MS Excel, Word, & PowerPoint

1. Looking after the corporate client & their empanelment’s 2. Preparing bills of TPA, ESIC, ECHS, CGHS and other Private clients Independently. 3. Handling all queries related to patients. Call me on +91 97739 85718

Graduate Medical background, MR (B pharma), BHMS, BAMS/ MBA in Hospital Adminstration 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 own vehicle to travel in various hospital assigned to him Candidate must be computer literate and shall possess skills including but not limited to Microsoft Office Suite and navigating through internet Portals Candidate will be mapped with minimum 20 hospitals for physical visit based on the location and city. Additionally 20-25 Hospitals for Case Audit and Management Proficient in handling complex situations and customers. Candidate must possess clinical knowledge for evaluation of medical files Sound knowledge of surgical procedures and disease cure management

Graduate Medical background, MR (B pharma), BHMS, BAMS/ MBA in Hospital Adminstration 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 own vehicle to travel in various hospital assigned to him Candidate must be computer literate and shall possess skills including but not limited to Microsoft Office Suite and navigating through internet Portals Candidate will be mapped with minimum 20 hospitals for physical visit based on the location and city. Additionally 20-25 Hospitals for Case Audit and Management Proficient in handling complex situations and customers. Candidate must possess clinical knowledge for evaluation of medical files Sound knowledge of surgical procedures and disease cure management

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TPA Executive - Hospital or insurance

Role & responsibilities 1) 1-3 years working experience in health insurance/health insurance TPA at Hospital handling/audit 2) Candidate must have excellent knowledge of health insurance / Health TPA domain. 3) Candidate must have excellent bill/medical negotiation skills & customer handling skills. 4) Good communication skills in Hindi/English and regional language of the state/region. 5) Ready to relocate himself/herself at location within India as may be required according to the job requirement . 6)Candidate must own vehicle to travel in various hospital assigned to him 7) MS Office and excel Preferred candidate profile Proficient in handling complex situations and customers. Candidate must possess clinical knowledge for evaluation of medical files Sound knowledge of surgical procedures and disease cure management Candidate will be mapped with minimum 20 hospitals for physical visit based on the location and city. Additionally 20-25 Hospitals for Case Audit and Management.

Role & responsibilities 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 insurance company. Efficiently and effectively handle grievance / issue raised by hospital staff & patients, escalate issue to the team leader, as when necessary. Follow-up and Updates to be given to the clients Required Skills and Experience Education: Any Diploma, Graduation, or Under Graduation. Experience: 6 months to 1 year in hospital or insurance roles (preferred). Strong communication and problem-solving skills. Ability to multitask, prioritize, and work efficiently. Detail-oriented with a professional and confidential approach.

Key Result Areas Supporting Actions To build an ecosystem that would assess/ recommend/ decision the viability of credit lending proposals based on institutionalized processes and dynamic market information The role needs to mitigate the title risk in retail loan proposals/facilitate the approving authority to take decision on the proposal. To be responsible for ensuring the legal assessment, approval and recommendation of all retail/ prime/affordable/CF proposals. Reviewing of PDD/ escrow, maintaining MIS and monitoring of exceptions. Formulation of product/policy/procedures by interacting with internal/external stakeholders in the field of legal due diligence during the entire life-cycle of loan portfolio. Guiding the business/credit/risk team on the referrals/ escalations on a day-to-day basis. Providing guidance on the exceptional events, conflict management, strategic decision on the Company s approach on given situations. Preparation/maintenance of legal/collateral acceptance policy & procedures. To be responsible for APF legal vetting, CF proposal legal vetting, drafting of covenants specific to transaction/s, upkeeping of Retail legal agreements, procedures & drafts. Drafting of Legal documentation and releasing EVs for execution within shortest TAT and driving entire LDD process with external empanelled lawyers. To develop formats and norms for approval, ensure their ratification within the team and from approval authorities in the system and institutionalize the prescribed process To engage with various business units (credit, operations, collections, sales, Channel partners, DSAs and other distributors) for optimizing the business opportunities and imparting required trainings. To suggest measures for ensuring workability of the loan proposals to the RMs, keeping risk in check like suggesting risk mitigation for the identified risks. To draft or vet and negotiate, with precision and as per applicable laws, regulations and judgments, contracts , undertakings or documents with vendors, service providers, lenders, co-lenders, other financial institutions and other third parties To ensure efficient Turnaround time (TATs) for validating the proposals To ensure TAT within SLAs for panel advocates on title opinion reports, search reports, deferral/escrow account management. To effectively deploy processes and mechanisms for ensuring high quality TATs for validating lending proposals & share the same with all concerned To liaise with the credit committee and pricing committees for closing the approval process after validation from risk To ensure prompt resolution/ explanation of queries raised by sanctioning authorities. To recommend delegation authority to zonal, regional and local teams To regularly provide inputs for new products, processes & credit lending norms To provide inputs and suggest amendments for newer Product Policy, Processes to be adopted keeping the current regulatory and compliance environment To ensure that the team stays abreast of all the latest developments in the lending space. To undertake improvements in approval notes and other processes to meet dynamic market environment and needs of new customer segments To perform portfolio monitoring and analytics for effective risk monitoring Analysis of non-recoverability of loan due to defective title, possession issue, builder disagreement, TPA issue, sale deed defects, Failure in security creation in takeover accounts, seller BT accounts, gap identification and fixing of responsibility, action/s to be taken etc. Continuously take steps to change the strategies according to the portfolio behaviors in terms of sectors/geographies etc. To review the covenants of loan proposals at frequent intervals and undertake action for serious deviations. To review reports and analytics on repayment schedules, covenant monitoring, modification in terms and loan sanction, etc Protect from potential loss on the credit portfolio by detecting early warning signals of deteriorating risks and advising these to the various business units and senior management. To work closely with the collection team and legal team to take action against defaulting parties Addressing the need of Stakeholders Collaborating and dealing with various internal & external stakeholders to address their needs in terms of portfolio quality, monitoring and adherence to the regulatory norms. ECL Management Continuously keeping a track of ECL cost and requirements as per the external & internal guidelines. To construct, monitor and highlight MIS To design MIS templates, monitor their data analysis and accumulation and ensure that key parameters are highlighted to all concerned stakeholders. To work towards skill enhancement and team building To guide teammates for better customer acquisition & provide them best-in-class knowledge on selection norms, new ways of proposal analysis & new concepts Inculcating a risk culture across the business group (i. e. ) the risk team, credit team, Technical team and the sales team.

Job Description 1 Graduate Medical background, MR (B pharma), BHMS, BAMS/ MBA in Hospital Adminstration 2 2+ Years working experience in health insurance/health insurance TPA at Hospital handling/audit 3 Candidate must have excellent knowledge of health insurance / Health TPA domain. 4 Candidate must have excellent bill/medical negotiation skills & customer handling skills. 5 Good communication skills in Hindi/English and regional language of the state/region. 6 Ready to relocate himself/herself at location within India as may be required according to the job requirement 7 Candidate must own vehicle to travel in various hospital assigned to him 8 Candidate must be computer literate and shall possess skills including but not limited to Microsoft Office Suite and navigating through internet Portals 9 Candidate will be mapped with minimum 20 hospitals for physical visit based on the location and city. Additionally 20-25 Hospitals for Case Audit and Management 10 Proficient in handling complex situations and customers. 11 Candidate must possess clinical knowledge for evaluation of medical files 12 Sound knowledge of surgical procedures and disease cure management

• 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 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 terms and conditions within the TAT. Interested candidate can share your resume to varsha.kumari@mediassist.in

Roles and Responsibilities Handle claims from receipt to settlement, ensuring timely and accurate processing. Verify claim documents, including medical records, bills, and reports. Coordinate with hospitals, doctors, and other stakeholders for necessary documentation. Conduct thorough investigations into complex cases to resolve disputes efficiently. Ensure compliance with regulatory requirements and company policies.

Job Description: We are looking for a dynamic and detail-oriented Medical Operations Executive to join our team. You will be responsible for coordinating and executing medical services for clients, ensuring smooth communication between doctors and patients, and maintaining proper documentation. Responsibilities: Coordinate end-to-end medical services for corporate clients and patients. Maintain a high level of accuracy in medical data entry and operational documentation. Liaise between doctors, patients, diagnostic partners, and internal teams. Support virtual consultations, second opinions, and medical report collection. Ensure timely scheduling of health check-ups, teleconsultations, and follow-ups. Handle escalations and operational issues efficiently. Skills Required: Excellent communication skills (written & verbal) Strong coordination and multitasking ability Knowledge of basic medical terminology Proficient in MS Office (Excel, Word, Outlook) Good understanding of healthcare operations and patient handling Ability to work under pressure and meet TATs Why Join Us? Work in a growing healthcare organization with a patient-first approach Opportunity to work with reputed doctors and healthcare professionals Fast-paced, learning-oriented work environment Scope for growth within the Medical Operations team

Overview Hi Team, I am currently working at CTS Speciality Hospital in the Insurance Department, where I have been for the past year. In total, I have over three years of experience in the health insurance sector, handling various responsibilities related to medical claims, policy coordination, and patient insurance support. I am confident that my experience and skills in health insurance operations make me a valuable asset for roles in this field. Tagged as: insurance Before applying for this position you need to submit your online resume . Click the button below to continue. Related Jobs Financial Advisor AGEAS FEDERAL GROUP Bangalore Freelance 2025-03-14 RELATIONSHIP OFFICER IN BANK Bank Jorhat Full Time 2024-01-19 TPA Insurance Operations Star Health & Allied Insurance Co. Ltd Chennai, Tamil Nadu Full Time 2025-01-20

Overview Roles & Responsibilities: 1) Candidates Should have worked in hospital Insurance desk 2) Provide Medical opinion for health Insurance claims 3) Processing of cashless requests & Health Insurance claims document 4) Proficient with medical terms & system 5) Understanding of policy terms & system. 6) Understanding of Claims adjudication/ Claims Processing Tagged as: insurance Before applying for this position you need to submit your online resume . Click the button below to continue. Related Jobs RELATIONSHIP OFFICER IN BANK Bank Jorhat Full Time 2024-01-19