406 Tpa Jobs - Page 6

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 enhancing effectiveness, or mitigating the risks, of specific policies and procedures by: Identifying and considering all applicable policies, laws, rules, and regulations of the firm, regulators, or other authoritative bodies as part of engagement team; Communicating with the client to understand key IT and business processes, identifying key risks; Prioritizing key risks, and assesses their impact and likeliness of occurrence; Applying professional skepticism while evaluating the control effectiveness; Documenting business and IT processes and controls and tests key controls for service organizations in a variety of industries; Documenting and validating the operating effectiveness of the clients control; Developing and maintaining relationships with client personnel and management; and Ensuring technology is appropriately integrated into the examination process. GAAS Applies knowledge and understanding of professional standards; application of the principles contained in professional standards; and the ability to document and communicate an understanding and application of professional standards on an engagement by: Developing and applying an intermediate knowledge of auditing theory, a sense of audit skepticism, and the use of BDO audit manuals; Applying auditing theory to various client situations; Documenting working papers and attestation reports in line with BDO policy, identifying deviations and notifying more senior team members in order to obtain appropriate approvals; Applying knowledge to identify instances where testing may be reduced or expanded and notifying more senior team members of the occurrence; and Contributing ideas and opinions to the engagement team. Methodology Applies knowledge and application of BDO standards to guide effective and efficient delivery of quality services and products by: Completing all appropriate documentation of BDO work papers; and Ensuring assigned work is performed in accordance with BDO methodology and requirements. Research Applies methodology used to seek or maintain information from authoritative sources and to draw conclusions regarding a target issue based on the information by: Researching basic and intermediate topics and forming an initial opinion on the treatment independently. Training Attend professional development and training sessions on a regular basis Complete required CPE hours to maintain applicable certifications Other duties as required

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 and timely resolutions. Manage claims escalations, ensuring prompt resolution while maintaining a customer-centric approach. Required Skills: In-depth knowledge of corporate group medical insurance policies and claims processing. Ability to understand medical terminology, treatment procedures, and health-related documentation. Proficient in Ozontel, Freshdesk, or similar customer support and claims management tools. Strong communication and problem-solving skills to manage customer relationships and resolve issues effectively. Attention to detail to ensure accuracy in claim processing and documentation review. Ability to collaborate effectively with cross-functional teams, including insurance partners and hospital networks. Qualifications: Bachelor s degree in healthcare, insurance, or related field preferred. 2-4 years of experience in claims processing, CRM role preferably within group medical corporate policies.

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 and timely resolutions. Manage claims escalations, ensuring prompt resolution while maintaining a customer-centric approach. Required Skills: In-depth knowledge of corporate group medical insurance policies and claims processing. Ability to understand medical terminology, treatment procedures, and health-related documentation. Proficient in Ozontel, Freshdesk, or similar customer support and claims management tools. Strong communication and problem-solving skills to manage customer relationships and resolve issues effectively. Attention to detail to ensure accuracy in claim processing and documentation review. Ability to collaborate effectively with cross-functional teams, including insurance partners and hospital networks. Qualifications: Bachelor s degree in healthcare, insurance, or related field preferred. 2-4 years of experience in claims processing, CRM role preferably within group medical corporate policies.

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 departments to settle the query. Resolving escalations from other departments Responsible to monitor Key performance Indicators, Responsible for corrective and Preventive action Responsible to ensure Inspection and Correct response to the customer calls To liaison with major Corporates / Insurer for ID card issues, Claim related issues, Cashless authorizations, Endorsements and Renewal of policies. Retention of clients, Meeting key stakeholders for weekly/monthly/quarterly portfolio review Managerial & Behavioral Punctual, Drive for results, Decision Making skills, Excellent communication, customer service and interpersonal skills. Exceptional analytical and listening skills, Team Management, Functional, Excellent problem-solving and communication skills. Solid customer focus and should be able to operate well in teams. Good telephone manner, Ability to develop and motivate staff, Great confidence and an excellent business sense. Should be able to set, satisfy, and exceed targets. Interested candidate can send their resume on roopa.kulkarni@mediassist.in Or simply on Naukri. Location: Begumpet, Hyderabad Company Name : Medi Assist TPA Pvt. LTD

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 patients in a timely manner. As part of your responsibilities, you will be involved in scheduling and rescheduling appointments, as well as preparing comprehensive Third Party Administrator (TPA) files and submitting them to the Finance department. It will also be crucial for you to address any deficiencies or queries raised by insurance companies and coordinate effectively with various hospital departments. Qualifications: - Graduation in any stream/Post Graduation/Diploma in any stream Experience: - 0-3 years of relevant experience To apply for this position, please share your updated resume at 8169272723. Job Type: - Full-time Benefits: - Health insurance - Provident Fund Schedule: - Rotational shift Education: - Bachelor's degree (Required) Experience: - Total work: 1 year (Preferred) - Customer service: 1 year (Required) Language: - English proficiency (Required),

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 receiving the payment it is been settled against the respective credit bills and the same is sent to accounts. Attending to patient/company queries as and when it is required. Give them the information required. Any other jobs to be attended as and when there is an instruction from the Senior Associate/H.O.Ds.

Explore Our Hospital Connect with Us Our Regional Presence Career Opportunities HIS Software LIS Software More Home Appointments Consultation Schedule Appointment Booking Health Check-Up Packages Blood Analysis Packages Healthcare at Doorstep Diagnostic Services Cashless Services Cashless Mediclaim (TPA) Swasthya Sathi West Bengal Health Scheme ESI Scheme DNB Programs DNB Programmes (NBEMS) DNB - DMRD Paramedical Courses Paramedical Education Hub Laboratory Tech - DMLT Radiography - DRD Physiotherapy - DPT Dialysis Technology - DDT Critical Care - DCCT OT Technology - DOTT Optometry - DOPT ECG Technology Neuro Electro Physiology Paramedic Student Corner Apply Today Reach Us Explore Our Hospital Connect with Us Our Regional Presence Career Opportunities HIS Software LIS Software Home Appointments Consultation Schedule Appointment Booking Health Check-Up Packages Blood Analysis Packages Healthcare at Doorstep Diagnostic Services Cashless Services Cashless Mediclaim (TPA) Swasthya Sathi West Bengal Health Scheme ESI Scheme DNB Programs DNB Programmes (NBEMS) DNB - DMRD Paramedical Courses Paramedical Education Hub Laboratory Tech - DMLT Radiography - DRD Physiotherapy - DPT Dialysis Technology - DDT Critical Care - DCCT OT Technology - DOTT Optometry - DOPT ECG Technology Neuro Electro Physiology Paramedic Student Corner Apply Today Reach Us Explore Our Hospital Connect with Us Our Regional Presence Career Opportunities HIS Software LIS Software

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 Physician, Hospital insurance desk, Field Visit Drs, Investigation officers)for hassle-free claim processing . To expertise ,the process of negotiation when necessitated. The claim handler owes a duty of care to the patient, ensuring that their needs are being met and that they re receiving the treatment or medicine they need. Job Qualifications and Requirements: Required BDS, BHMS, BAMS, MD, Pharm D Graduates. Adapt and inbuilt the process of communication and coordination across the zones and the supporting verticals accordingly.

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 Location Indore Surat Mumbai Nagpur Chennai Bangalore Kochi Kolkata Noida Hyderabad Vishakapatnam Chandigarh Vadodara

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. Coordination with Broker, Insurance Company and Corporate Client etc. Experience required: Experience: 2-4 years of experience in Customer Service or Client Relationship roles in Health Insurance or TPA Company Personal Attributes and Competencies: Strong verbal, written, presentation and persuasive skills that effectively communicates with Experience of making and developing strategies Strong negotiation skills that demonstrate creative, innovative problem-solving approaches to complex situations. Strong analytical and problem-solving skills. Interested Candidate can connect -09971006988

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 experience as a Trainer, preferably in the insurance or healthcare domain . Excellent communication and presentation skills. Strong understanding of health insurance claims lifecycle is an added advantage. Ability to simplify complex information for diverse learners. Proficiency in MS Office, online training tools (Teams, Zoom), and documentation. Patience, empathy, and a people-first attitude. Preferred: Prior experience training in TPA, insurance BPO, hospital billing, or claims environments is an added advantage. Knowledge of IRDAI regulations , claim documentation, and reimbursement/cashless processes.

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 Companies/Corporate etc.. 5.. Oversee department functions like the Customer Care, Claims, Preauth and related functions. 6.Claims and Cashless settlement 7. Coordination with Broker, Insurance Company and Corporate Client etc. Experience required: Experience: 2-4 years of experience in Customer Service or Client Relationship roles in Health Insurance or TPA Company Personal Attributes and Competencies: Strong verbal, written, presentation and persuasive skills that effectively communicates with Experience of making and developing strategies Strong negotiation skills that demonstrate creative, innovative problem-solving approaches to complex situations. Strong analytical and problem-solving skills. Interested Candidate can connect -09971006988

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 staff based in program countries. In India, CHAI works in partnership with its India registered affiliate William J Clinton Foundation (WJCF) under the guidance of the Ministry of Health and Family Welfare (MoHFW) at the Central and States levels on an array of high priority initiatives aimed at improving health outcomes. Currently, WJCF supports government partners across projects to expand access to quality care and treatment for HIV/AIDS, Hepatitis, tuberculosis, COVID-19, common cancers, sexual and reproductive health, immunization, and essential medicines. Learn more about our exciting work: http: / / www.clintonhealthaccess.org Project Background: Over the years, Government of India has taken significant strides towards achieving universal access to equitable, affordable, and quality healthcare services, by extending a range of health schemes/ programs that provide access to primary, secondary, and tertiary care through public health facilities. To consolidate and further augment the provision of health services, the Hon ble Prime Minister of India launched Ayushman Bharat Yojana in 2018, which has four key pillars, namely, Ayushman Bharat Health and Wellness Centre (AB HWC), Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (AB PM-JAY), Ayushman Bharat Digital Mission (ABDM), and Ayushman Bharat Health Infrastructure Mission (AB HIM). Each of these pillars complements and enables the others, thereby enabling the holistic delivery of health services. In Madhya Pradesh, the State Health Agency (MP SHA) is responsible for the implementation of ABDM and AB PM-JAY and concerted efforts are being made to improve utilization of PMJAY through establishment of a state level call centre to support care seekers. Over four crore Ayushman Bharat Health Accounts (ABHAs) have been created and over ~13,000 health facilities registered and verified on Health Facility Registry (HFR). The state is now actively working on catalysing these large platforms to broaden access to healthcare. The William J. Clinton Foundation (WJCF) proposes to support the Madhya Pradesh State Health Agency (MP SHA) in implementing an integrated call centre-based solution and enhancing the services extended through the same to, amongst others, include creation of their ABHA IDs while making care seekers aware of the benefits/services, administering an adaptive health assessment tool to support Electronic Health Records (EHR) and supporting a ticketed appointment at various empanelled facilities (including teleconsultations, where operational). The project is being undertaken in the 5 districts of MP Bhopal, Sehore, Indore, Ujjain, and Dewas to assess the viability of a readily scalable call-centre based solution, improve access to timely health services, especially for women, and assess reduction in delays in service delivery and provide for patient feedback to improve services and accelerate the generation of ABHA-linked records. Position Summary: The Program Officer will play a key role in ensuring the effective implementation of the Care Integration Program through oversight of both field and call centre operations. The role involves supervising the Telecaller Team Lead (TL) and supporting the day-to-day functioning of the call centre hosted at the State Health Agency (SHA), while also engaging with private PM-JAY empanelled hospitals to strengthen service delivery. The PO will mentor and manage the implementation team, monitor key program indicators, and ensure the timely execution of planned activities. They will also support coordination with government stakeholders and partners at the district and state levels. The role requires providing timely inputs to the WJCF/CHAI team, conducting supportive supervision visits, and upholding strong standards of program and fiscal accountability. The Program Officer will represent the organization in stakeholder meetings, reviews, and workshops across state, district, and block levels Responsibilities Oversee daily operations of the call centre by supervising the Telecaller Team Lead (TL) and ensuring seamless functioning at the State Health Agency (SHA). Support the development and periodic revision of call centre protocols, workflows, and call scripts to ensure alignment with program needs. Drive quality assurance by assisting the TL in planning and executing quality checks; analyze audit findings and initiate corrective actions or escalate as required. Monitor team performance, provide constructive feedback, and collaborate with the state team to strengthen individual and team capabilities. Liaise with relevant stakeholders at SHA and the Third-Party Administrator (TPA) to support efficient call centre operations. Lead engagement with private PM-JAY empanelled hospitals; conduct regular field visits (~30% time) to monitor implementation and resolve operational challenges. Coordinate outreach efforts with community stakeholders to promote utilization of Care Integration services under AB PM-JAY. Build capacity of district-level teams through ongoing mentoring and training, particularly on private sector hospital engagement. Document field insights, lessons learned, and implementation challenges; prepare and submit timely progress reports. Engage with senior district officials to identify bottlenecks and collaborate with the WJCF state team to design and implement mitigation strategies. Coordinate with state health authorities, IT teams, and implementation partners to support smooth execution of the program. Undertake additional tasks as required in alignment with program priorities and in consultation with the WJCF team. Qualifications Master s degree in Public Health, Management, Public Policy, or a related field, with at least 8 years of relevant work experience in a demanding, results-driven environment. Proven ability to lead and support field implementation in public health programs, with a strong understanding of program protocols, supervision, reporting, and adherence to operational procedures. Experience engaging with government stakeholders and development sector partners at both the state and district levels. Strong organizational skills with the ability to manage multiple tasks, set priorities, and work independently with minimal supervision. Willingness to travel extensively within the program state (10 12 days per month). Excellent verbal and written communication skills in both Hindi and English. Ability to synthesize and present complex information clearly, including technical content, through high-quality presentations and reports. Demonstrated capacity to thrive in fast-paced, high-pressure environments. Proficiency in Microsoft Office applications, particularly Excel, PowerPoint, and Word. Preferred: Prior experience in implementing public health programs, especially at the community or district level. Last Date to Apply: 7th August 2025

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 with be mention Details Total Experience Current City Current Company Home Town Current Salary Expected Salary Notice Period

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 to pass or clear the Health Insurance claims. Qualifications Bachelor's degree. Previous experience in TPA management or Banking. Good interpersonal and communication skills. Isha Thakur 9056448144 HRD

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 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

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 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

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 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

Role & responsibilities Manage insurance claims from receipt to settlement, ensuring timely processing and resolution. Coordinate with TPAs (Third Party Administrators) for claim adjudication and settlement. Handle mediclaim claims, health insurance claims, and other types of general insurance policies. Ensure accurate billing and reconciliation of patient accounts. Maintain records of all interactions with patients, providers, and insurers. Preferred candidate profile 5-8 years of experience in insurance coordination or TPA coordination role. Strong knowledge of insurance billing, claims processing, and claims settlement procedures. Proficiency in handling multiple tasks simultaneously under tight deadlines. Excellent communication skills for effective interaction with customers (patients), providers (hospitals), and insurers. Perks and benefits As per industry

We are hiring medical officers for cashless claims processing. Ideal candidates have 0-2 years in TPA/insurance with BAMS/BHMS. Strong medical knowledge and understanding of health policy terms are required.

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 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 environment and offers a flexible operating model that can meet the unique needs of each market segment.Claim processing team collects end-end data dataDevelop and deliver business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for Ability to establish strong client relationshipAbility to handle disputesAbility to manage multiple stakeholdersAbility to meet deadlinesAbility to perform under pressure- Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation

Greeting from Medi assist TPA Pvt ltd. Hiring Medical officer for Insurance Claim processing Profile Location- Mumbai -Andheri East. Role - Medical officer Exp : 0-8 years Job description : * 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 Interested candidate can drop there resume in my Mail ID : varsha.kumari@mediassist.in We are looking for fresher or exp candidates BAMS, BHMS, B.sc Nursing, BPT mail id - varsha.kumari@mediassist.in Thanks & Regards Email: varsha.kumari@mediassist.in