1024 Tpa Jobs - Page 6

Job Summary: We are seeking a qualified and experienced medical professional with a strong background in health insurance claim settlement and customer service . The ideal candidate will leverage their clinical knowledge to evaluate and process health insurance claims efficiently while ensuring a high level of customer satisfaction. This hybrid role bridges the gap between medical accuracy , regulatory compliance , and empathetic customer support . 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. Co...

Vidal Health Insurance TPA is hiring for AVP CRM/Client Servicing role for large corporate accounts Job Location: Gurgaon Interested candidates can send their resumes on tiju.jose@vidalhealth.com Key Responsibilities: 1. Management and Retention of Top corporate for the region. 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 of top stakeholders for the respective region. 4. Oversee timely submission of MIS reports to Insurance Companies/Corporate etc. 5. Relationship with HO of Insurance Companies, Brokers etc... 6. Service fees collection for the region. 7. Oversee department ...

Health Claims, Mass Claims & Provider Management, tpa Experience in HCP

Job Summary A Neurologist is needed to diagnose and treat conditions affecting the brain, spinal cord, nerves, and muscles. The role requires expertise in identifying and managing a wide range of neurological disorders. Key Responsibilities Diagnose and treat neurological conditions, including stroke, epilepsy, migraines, and Parkinson's disease.Conduct neurological examinations and interpret diagnostic tests like MRIs and CT scans.Develop and manage treatment plans, including medication and physical therapy.Collaborate with neurosurgeons and other medical professionals as needed. Requirements MBBS degree and a postgraduate degree (MD/DNB) in Neurology.Valid medical license and registration.

Dear Candidates, Greetings from HealthIndia Insurance TPA Service Pvt. Ltd. Company Profile - We are provide highest level of quality health care by creating a platform which is entirely dedicated to service excellence, patient care and health education to the members . For more details kindly go through company website: https://www.healthindiatpa.com Currently we're having opening in Cashless Department for Medical Officer Profile. Role & Responsibilities: Cashless Claim Management: Review and process pre-authorization requests for cashless hospitalization, ensuring all required documentation is complete and accurate. Medical Scrutiny: Analyze medical records and reports to validate claims ...

Greetings from Vidal Health Insurance TPA Pvt Ltd., Openings For Medical Officer!!! - Non Clinical Role Qualification -MBBS-MCI Reg Experience - 0 to 1 Year Job Location - Bangalore(Whitefiled) Roles and Responsibilities Involved in analyzing medical reports and do medical Audit at the Hospitals. Should have medical knowledge. Providing quality services. Updating the new medical terms and conditions as per the policy. Should be good knowledge in Academics. Resolving Claims related queries and discrepancies, Following up and responding to queries of customers. Approving and Rejection of Payments to the Customers with all verification. Updating the Status of the Customers about the respective ...

Role & responsibilities : Manage the performance of the key accounts in the branches Set goals and targets for the teams. Monitor and review the performance of the team periodically. Preparation of reports which will be shared with other teams. Understand the training needs of team members, develop them through training, coaching and mentoring sessions. Handle escalations and associated documentation if any. Preferred candidate profile : Education: Min Graduation completion. Experience: 7+ years of experience with broker or hospital or insurance background preferred. Managed large accounts in a TPA/insurance/hospital background with ability to handle 10-20 team members. Location: Bangalore- ...

Will be responsible for leading & managing the overall operations & business development activities. This role requires strong leadership, operational excellence & client relationship skills to ensure smooth service delivery & business growth. Required Candidate profile Candidate MUST have experience in TPA *Operations Management *Business Development *Team Leadership *Compliance & Reporting *Client Relationship Management *Networking & Negotiation Skills

Perform daily ward rounds, monitor vitals, write progress notes, manage IV/IM medications, order investigations, insert IV lines/catheters, attend code blue, update consultants, and ensure accurate documentation as per hospital protocols.

The team of medical practitioner part of Pre-Authorization team will use their skills and expertise in authorizing the request received and they will ensure that the customers are attended on time by following the protocol of the policy defined by the insurer and the organization. Ensuring error free processing of preauthorisation within agreed TAT (Turnaround time) by way of following the following process, o By entering accurate information into the application defined by the organization. o Review structured clinical data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures defined by the insurer and the organization. o Inform prov...

Handle outbound calls, respond to customer queries/feedback, maintain CRM records, follow scripts, coordinate with teams, ensure quality support. No sales or targets. Tech skills: CRM, data entry, call logging, MS Office.

About The Role Skill required: Reinsurance - Collections Processing Designation: Claims Management Manager Qualifications: Any Graduation Years of Experience: 13 to 18 years 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 uniq...

Data reporting to Insurer authorities, Corporates, Brokers and TPA management. May13- till date Data interpretation, claim analytics, Fraud analytics, Loss and reserve analytics, trends, recommendations on the policy behavior are the key focused areas Publishing detailed analysis of specific corporate with respect to historical data available. Utilization patterns with respect to age, gender, Sum insured, relation, Location etc., Analyzing CTQs such as Average claim value, TAT, Morbidity ratio, Loss ratio etc. Impact analysis of implied disease sub limits, co-payments, room limits, savings etc. TAT reports: Establishes the FIFO movement of claims and the compliance of service delivery to cus...

Key Responsibilities: Handle and process cashless claims efficiently and within timelines. Coordinate with TPAs , insurance companies , and internal departments for smooth processing of patient admissions and discharges. Manage pre-authorisation, enhancement, and final approval processes for all cashless patients. Ensure accurate and timely documentation for CGHS , GIPSA , and private insurance claims. Track claim status, follow up on pending claims, and ensure timely reimbursements. Maintain up-to-date records and MIS reports. Coordinate with patients regarding insurance queries and documentation needs. Ensure compliance with standard protocols and hospital policies. Requirements: Minimum 2...

Greetings from Vidal Health Insurance TPA Pvt Ltd., Openings For District Medical Officer!!! - Non Clinical Role Qualification -MBBS-MCI Reg Experience - 0 to 1 Year Job Location - Chennai Roles and Responsibilities Involved in analyzing medical reports and do medical Audit at the Hospitals. Should have medical knowledge. Providing quality services. Updating the new medical terms and conditions as per the policy. Should be good knowledge in Academics. Resolving Claims related queries and discrepancies, Following up and responding to queries of customers. Approving and Rejection of Payments to the Customers with all verification. Updating the Status of the Customers about the respective Claim...

Role & responsibilities Responsible for managing client relationships with key decision makers Subject matter expert for partners and internal staff for the assigned product Addresses the gaps identified between client requirement & the service provided Ensure that the service is delivered in accordance with the agreed service level agreement Act as a point of contact for any escalation or feedback from clients Collaborate with the other functional Group to evaluate the product performance and to recommend Refinements and improvements in service performance Establish and maintain on-going partner relationships and anticipate and resolve potential problems of the client Announcements of new u...

Greetings from Vidal Health Insurance TPA Pvt Ltd., Openings For District Medical Officer!!! - Non Clinical Role,Immediate Joiners Preferred Qualification -MBBS(FMG - Non MCI)/BDS Experience - 0 to 1 Year Job Location - Chennai Roles and Responsibilities Involved in analyzing medical reports and do medical Audit at the Hospitals. Should have medical knowledge. Providing quality services. Updating the new medical terms and conditions as per the policy. Should be good knowledge in Academics. Resolving Claims related queries and discrepancies, Following up and responding to queries of customers. Approving and Rejection of Payments to the Customers with all verification. Updating the Status of t...

Minimum Mandatory Skill Set Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Brief Job Profile Claims adjudication, Fraud and leakage control, Client/provider feedback, Team training and retention, Investigation Desired Competencies/ Skill Set MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, computer skills. Preferred Industry Health Insurance, TPA, Hospitals, Healthcare

Minimum Mandatory Skill Set Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Brief Job Profile Claims adjudication, Fraud and leakage control, Client/provider feedback, Team training and retention, Investigation Desired Competencies/ Skill Set MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, computer skills. Preferred Industry Health Insurance, TPA, Hospitals, Healthcare

You will be responsible for accuracy in in-patient billing and coordinating IPD & OPD patients for surgery estimations. Your main tasks will involve processing & coordinating for TPA and Credit approvals, providing estimates to patients and concerned companies within 24 hours of admission, and obtaining further approvals for surgical packages exceeding the stay limit. You will need to verify if all documents are as per TPA requirements and file them properly. Monitoring approvals from insurance companies and following up on emergency admission patients will also be part of your role. Your key responsibilities will include: - Monitoring day-to-day outstanding amounts and following up on them ...

Role & responsibilities Claims processor Preferred candidate profile BDS,BHMS & BAMS Freshers

Well versed with Cash/Credit /TPA/CGHS Billing Interested Candidate may share their interest along with the updated resume on apshr01@gmail.com or feel free to call on Rahul Bajpai - 8299057961

Urgent requirement for Kolhapur:( Shahupuri) Freshers candidate required . Interested candidates can call on 9371762436 or share their updated resumes to career@mdindia.com Looking for Fresher candidates Fresher graduate Inward & Outward Operations Claims Lodging / filling Enrollment CBF Activities ssuring you of our consistently best services. Regards, Omkar Newale Sr. Executive - Talent Acquisition

Job Description ( CRM - Client Servicing) Communicating with clients via phone calls, emails, or in-person . Identifying and resolving client queries Maintaining a detailed and accurate record of all client details and communications Building and maintaining long-lasting business relationships with clients Ensuring to respond to client queries in a professional and timely manner Assisting in the hiring process and providing necessary guidance to the team members and new recruits Providing clients with relevant information on the products and services offered by the company Identifying and making promotional/marketing offers to potential clients Achieving the monthly/yearly revenue targets Pe...

A TPA (Third Party Administrator) Executive's job description can vary based on the specific company or industry they work in However, here's a generalized job description for a TPA Executive:Job Title: TPA ExecutiveJob Summary:As a TPA Executive, you will be responsible for managing and overseeing various aspects of third-party administration services for clients Your primary goal will be to ensure the smooth and efficient processing of claims and other administrative functions while maintaining high levels of customer satisfaction You will collaborate with internal teams and external stakeholders to deliver exceptional service and meet client expectations Responsibilities:Claims Management...