406 Tpa Jobs - Page 7

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

Handling all debtor receivables, Solving all querieswhich are related to bill. Checking all IP files before dispatch. Checking the reasons of cancellation of billfree billdiscount billrefund bill. Making the changes of packages rates/tests rates as per the Company Agreement. Maintaining the Debtors aging report for OP & IP Communicate with the companies and TPA s for follow-up on the payments of bills. Interaction with the patients for payments of the dueswhich are not made by the TPA or company. Check the bottlenecks that arise in the payments and solve the problems regarding the bills Decisions making regarding payments high amount bills to reduce the outstanding of the company.

Process health insurance claims. Should have knowledge of cashless and reimbursement. Location - Chembur. Should have knowledge of excel. Graduation mandatory. Call or send your resumes on 8097516521. TPA experience Mandatory

Responsibilities: * Manage patient care in emergencies * Conduct claim investigations * Process health claims * Adjudicate claims fairly * Collaborate with TPAs on case resolution

Walk-in Drive || Clinical Doctors || Cotiviti Pune || IPDRG || Fresher & Experienced || Walk-in Date : 12th Jul 25 Walk-in Time : 10 AM to 2 PM Job Location : Pune Venue : COTIVITI INDIA PRIVATE LIMITED - Plot C Binarius Building 190 / 192 Plot C, Deepak Complex, National Games Road Off Golf Course, Shastrinagar, Yerawada, Pune, Maharashtra 411006 Eligibility : Fresher Eligibility Criteria : Medical Degree (MBBS or BAMS or BHMS or BPT) with Clinical experience or US Healthcare experience Strong analytical, critical thinking and problem solving skills Should have general knowledge on Medical Procedures, Conditions, illness & Treatment Practices Excellent verbal and written communication skills Should be ready to work in night shifts during training time Experience Eligibility Criteria : Any graduates with IP DRG Experience (Min of 1+ years) Active credentials through CIC & CCS is mandatory Excellent verbal and written communication skills Should be ready to work in night shifts during training time Interested candidates can share resume - abdul.rahuman@cotiviti.com or contact the below number Regards, Abdul Rahuman | Sr HR Executive 9080276094

Job Description Coordinate with patients, insurance companies, and internal departments for smooth processing of cashless claims. Facilitate timely pre-authorization approvals and ensure all required documents are submitted. Maintain records of all TPA communications and claim documents. Handle queries from patients and their attendants regarding insurance claims. Follow up with TPAs/insurance companies for pending approvals and payments. Reconcile TPA receivables and ensure timely payment posting and recovery. Assist the billing team in preparing final bills for insured patients. Ensure compliance with hospital policies and insurance guidelines. Regularly update TPA software and internal MIS systems with accurate information. Required Candidate Profile: Any Graduate with 1 to 5 years of experience in hospital insurance. Pleasant personality with good communication and interpersonal skills. Basic computer proficiency and familiarity with hospital billing/TPA processes. Ability to work in a fast-paced hospital environment. Interested candidates please forward your resume to the below mentioned contact number Thanks & Regards, HR Team- 7299052617. Miot International.

Clients: 1. Relationship Management 2. Maintain TAT for all assignments 3. Maintain healthy relationship with insurance companies and TPA 4. Ensure Proper and Systematic documentation (folder management) 5. Claims Management (GPA and GTL claims Tracker, GMC Outstanding claims tracker) 100% adherence to the service design for clients as per the service design identified as below:-. Renewal activity (Intimation+calendar, Plan design + QCR etc., policy placement Monthly activity report to clients + Claims MIS + Claims UR + Health & Wellness letters + HR Connect Maintaining strong vendor relationships - Client, Insurer & TPA Client meetings with MOM being mandatory, (Monthly meetings compulsory for all clients with revenue above Rs 3 Lacs & for other clients quarterly ones) Minimize client escalations to be received - Maximum 3 per year Client Records Management (Premium register, Data recon, CD statement etc.) Monitoring claims TAT as per laid out standards (3% above 25 days) Communication Initiatives (Benefits Manual, Mail communication to the client, TPA & Insurer on the renewal is mandatory including orientation sessions. Execute wellness program for clients as per laid out standards i.e. Wellness calendar-Health talks & Camps-(For all clients above Rs 3 lacs revenue) Financials / Business KPIs Retention Revenue Target as fixed by business - Cross Sell (10% of overall current revenue) | Retain 100% of clients by revenue managed including cross sell revenues | Retain 95% of overall revenue to be maintained No. of accounts handled and how to improve the number or efficiency Overall revenue book managed from last year and enhancement - Upsell (enhancement of programme / limits etc.) | Generate cross sell revenue from existing EB clients SAIBA Booking within timeframe Uploading of document in SAIBA Updating D365 client information Operational Excellence and Innovation Focus on ways to improve operational excellence and bring in efficiency Work with Client Mgmt. team towards smooth transition of new accounts Ensure business is fully compliant with all the regulations and all mandatory trainings, broker manual, SPOE etc. for self and team members Innovative Client Retention Strategies Innovate New products, Expertise, Capability, Influence Cross Selling Strategies BQP Qualification for client facing colleagues Nil Exposure to E&O, Legal / Compliance Matters Act all times with integrity and keep company reputation unblemished, Excellence, People, Integrity Qualifications MBA/ Bachelors degree or equivalent work experience in related field Should have 7+ yrs of experience with Min 3 years of client facing experience, specially medical insurance. Experience in Insurance broking preferred, experience in brokers, Insurance Co. Demonstrated experience within in B2B environment Proven track record of meeting and exceeding targets. Excellent verbal and written communication skills, including facilitation of group presentations Proficiency in Microsoft Office applications, including Outlook, Word, Excel, PowerPoint and Access and industry-specific analysis software. Basic understanding of the insurance industry, with the ability to become a subject matter expert on the job. Innovation and problem-solving skills that include the ability to develop and propose equipment based solutions for clients

Manager-Segment Incharge The role is responsible for all tasks related to Processing and Settlement of claims, Monitoring TPA performance for the assigned business. The role includes managing the assigned specialized business handling of any one or more of the following activities: Settlement of Claims, Monitoring TPA performance based on defined KPI, System, Development, UAT, Portfolio Analysis, MIS/Compliance. If this is you, we are looking for you! Key Responsibilities Managing end-to-end claims. Requisitioning detailed information on all reported and settled Claims and monitoring performance of TPAs, evaluating performance of all TPA based on parameters of SLA with Regular Review of defined KPIs. Monitoring and performance evaluation of TPA including timely review of TAT & quality for various process followed in TPAs, daily TAT monitoring, escalation & expectations management for specialized business handling of retail portfolio. Maintaining and updating TPA records on daily basis which help us to know the performance of retail policies and portfolio. Conducting QC of reports and data of TPA shared with us on regular intervals to analysis the data on all benefits as per retail policies. Supporting Actions IT Systems Development System development for uploading and extracting TPA claims and generating reports from the same. Cost containment without losing on customer experience, actionable of feedbacks on claims experience. Educational Qualification: - Preferably MBBS, BHMS, BAMS Doctor Minimum 7-9 years in handling similar role Experience in handling provider management (Hospitals and other vendors) is mandatary. Its a urgent opening please share your resume at aparna@aceconsultants.in

Accuracy in Inpatient Billing. Effectively monitoring of day-to-day activities Resolve customer complaints or answer customers' questions regarding policies and procedures. Supervise the work of office, administrative, or customer service employees to ensure adherence to quality standards, deadlines, and proper procedures, correcting errors or problems. Provide employees with guidance in handling difficult or complex problems or in resolving escalated complaints or disputes. Implement corporate or departmental policies, procedures, and service standards in conjunction with management. Discuss job performance problems with employees to identify causes and issues and to work on resolving problems. Monitoring all estimations and actual billing expenses. Follow up of Emergency admission patient. Day to day outstanding amount follow up. Monitors OP / IP billings performance shift wise. Bill Updating of all the procedures done to the patient on daily basis. Ensures charges for the hospital services based upon the tariff. Gives estimation to the self-paying patients and Corporate Patients. To ensure that all the services are charged before final bill is made. Takes written consent from the Patients attendants on payment terms. Discuss with the consultants, estimate, deposits and payments. Explains the line of treatment being given and the reason for taking such deposits at the time of admission to the patients and their attendants. Gives break-ups of the treatment bills for re-imbursement, insurance claims. Provides inputs to Finance and Accounts department regarding day-to-day transactions Implementing admission & billing policies as directed by the management Tracking timely submission of bills of TPA & Corporate Maintaining MOU tracker. Maintaining all tariffs in soft copy and hard copy authorized sign. Co-ordination with internal departments. Maintaining Discharge TAT. Maintaining Estimation TAT. Giving on job training to staffs. Ensuring proper documentation for audit. Helping to concern person for timely TPA and Corporate renewals. Timely tariff revision. Daily MIS reports to the management.

At Amazon we believe that every day is still day one. We are working to be the most customer-centric company on earth. To get there, we need exceptionally talented, bright, and driven people. If you d like to help the Disability Leave Services (DLS) team build a best-in-class professional services program to deliver leave of absence, disability and accommodation services to Amazon employees, applicants, job seekers and candidates globally, this is your chance to make history by joining our team. DLS Provides services 7 days a week, 24 hours a day to assist employees as they go through qualifying life events. The DLS Case Manager provides case management for all types of leave of absence and disability life events. The DLS Case Manager is highly skilled in answering questions, understanding the employee s situation, applying the appropriate benefits, responding to changing circumstances and needs, and paves the way for a connected and trusted case management experience. Case Managers are the single point of contact for an employee throughout an entire leave of absence or disability event. Initiate and respond to inquiries about leave and disability events, benefits, and options available to employees Serve as a point of contact for assigned employees (150 200 employee cases) to provide holistic case management services, including reviewing medical documentation to adjudicate leaves in compliance with the corresponding leave plans, federal and state laws and benefit plans as defined by Amazon Leverage duration guidelines, best practice tools and Amazon resources to support oversight of a leave event as appropriate Critically assess and adjust the case management plan to an employee s changing needs Address and respond to sensitive situations Troubleshoot issues and seek to remove barriers before, during, or after a leave event Respond to employee impacting issues that may arise during the leave event and ensure the right communication occurs Identify and solve problems that may arise, sometimes with limited information Facilitate a smooth return to work and ramp-back plan for employees returning to the workplace Educate managers and business partners on employee concerns and needs prior to being off or returning back to work Communicate regular updates to employees and stakeholders both verbally and in writing Ensure compliance with standard work, federal/state regulations, and company policy Maintain system records to ensure accurate and timely information/documentation Consult, coordinate and partner with our third party administrator, HR, Safety, Legal, Payroll, Benefits, team members and other departments/systems as appropriate Flexibility to work nights and weekend Bachelor s degree or 5 + years of professional or military experience. 6+ years of work experience will qualify in lieu of a Bachelor s degree. 6+ months of experience as a DLS case manager supporting US Leaves. 1+ year of experience in Human Resources or customer service in a leave and/or disability field. Experience in MS Word, Excel, Access, Outlook and PowerPoint 2+ years of related experience in a leave of absence and/or disability claim management role Knowledge of federal or state Leave and Disability regulations, specifically ADA/ADAAA and FMLA Experience working multiple projects or cases independently in environment with changing priorities Experience working with confidential information SPHR, PHR, or CPDM certifications, or equivalent Experience providing case management services for a large, multi-state employer or on behalf of a carrier/TPA with clients in multiple states Experience with global service and employee delivery Strong problem solving, time management and priority setting skills Experience providing guidance to employees or managers on leave of absence, disability plan, accommodation, human resources, benefits, or employee matters

Key Responsibilities Single-point claim coordination: Act as the dedicated contact for motor claims third-party, own damage, and theft to ensure smooth communication between client, insurer, police, surveyors, and garages . Claim filing & documentation: Promptly report accidents/thefts to police and insurers; collect FIRs, policy details, driver statements, vehicle photos, keys (for theft), and other required documents . Survey & assessment management: Work with surveyors to assess damage; review findings jointly and determine claim admissibility, settlement value, and NCB implications . Negotiation & settlement: Liaise with insurers to pursue cashless workshops or reimbursement; negotiate and finalize settlements effectively . Process enhancement: Develop and refine SOPs for motor claims; ensure efficient resource allocation and monitor key process metrics like TAT and claim costs . Qualifications & Experience Bachelor s degree (Insurance/Finance preferred). 2 5 years of hands on motor insurance claims experience (brokerage, TPA, insurer, or fleet operations). Strong familiarity with IRDAI regulations, policy terms, and required documentation. Excellent coordination and communication skills. Skilled in negotiation and analytical decision-making. Basic IT proficiency; experience with claims management systems desirable.

About Us Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: 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. Handle escalations and responding to mails accordingly. Work from Office only Address: 4th floor, AARPEE Chambers, Off Andheri-Kurla Road Industrail Estate Marol, Andheri East, , Marol Cooperative Next To Times Square, Shagbaug, Gamdevi, Marol, Mumbai, Maharashtra 400059 Interested candidates can share their CV to dona.antony@mediassist.in or WhatsApp to 9632777628

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. * Motivating / retaining the team members. * Develop and implement organizational policies and procedures for the facility of customers. * Gathering and analyzing data (learning) and using it to plan and implement. * Sitting on Team Meetings and representing the views of clients * Regular Analysis for effective usage of the platform * Planning and implementing strategic changes to improve service delivery. * Extrapolating data for quality assurance and monitoring purposes. * Regular visit to hospitals to review and streamline the process, document and share MOMs * Other activities as assigned by your reporting manager. Flexible in Travelling, Good Communication skills Team Handling, Committed, Accountability and Responsibility.

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- 7631162388 Whatsapp CV mail id -varsha.kumari@mediassist.in

Job Description: Processing of Claims Health files. Claim Registration and Claim Adjudication. Identifying the Fraud. Adhering to SLAs and processing the claims with in the TAT as per policy terms and conditions. Supporting CRM, provider, sales and grievance teams. Eligibility Criteria: Pharm-D, BSc Nursing, B .Pharmacy freshers only(Qualified Graduates with all certificates in hand). Any Graduate with minimum 2+ years of Claims Health processing experience. Salary Budget - up to 4 lakhs. Job location Ameerpet, Hyderabad. Evaluation would be based on competency, age, experience, stability

Urgent requirement for Manager ( Talent Acquisition) interested candidates can call on 9371762436 Job Title: Manager -( Talent Acquisition ) Location: Corporate Office - Pune Department: Human Resources Primary Deliverable: To proactively ensure quality and efficiency in staffing, with minimal Turnaround Time. Major Accountabilities of the position: 1. Utilize various sources of recruitment to fill the positions at the earliest. 2. Screening and shortlisting of applications and proceeding to initiate the Interview process. 3. Coordinate with concerned Departmental Heads to track vacancies, and the candidates being interviewed. 4. Coordinate with the candidate for the mandatory documents and information required for recruitment process. 5. Maintain and update MIS reports of all recruitment data. 6. Work with the HR team to develop additional sources of recruitment and enhance the utilization of all existing sources. 7. Support and participate in new initiatives for recruitment all over Pan India. 8. Undertake any additional assignments given by the company from time to time. Preferred Candidate Profile: Graduation/Post Graduate with 5-8 years of Recruitment experience .Sound knowledge of Recruitment processes and HR practices. Professional Success Skills: Exceptional written and oral communication skills are prerequisites. Good in Excel. Ethical approach, with a compliance towards quality hiring. A go-getter with an upbeat personality. Interested Candidate can share there CV on career@mdindia.com or pnegi@mdindia.com

A TPA (Third Party Administrator) within the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) scheme typically handles the operational aspects of the program at the district level. This includes managing beneficiary identification, utilization of services, awareness generation, hospital network expansion, monitoring, audits, training, and reporting. They work to ensure smooth data flow to the state level and conduct routine visits to participating entities to verify adherence to defined standards. Here's a more detailed breakdown of the job description: Key Responsibilities: Supervision and Administration: Overseeing the overall administration of the PM-JAY scheme at the district level, including compliance with guidelines. Beneficiary Management: Ensuring accurate identification of eligible beneficiaries and facilitating their access to healthcare services. Service Utilization: Monitoring the utilization of services under the scheme, including pre-authorizations and claims processing. Awareness and Expansion: Generating awareness about the scheme among the public and expanding the network of participating hospitals. Monitoring and Auditing: Conducting regular monitoring and random audits of pre-authorizations and claims to ensure quality and timeliness of data. Data Management: Maintaining and reporting program data, ensuring its accuracy and completeness for report generation. Coordination and Communication: Working with various stakeholders, including the state health authority, hospitals, and other relevant parties, to ensure smooth operations. Quality Assurance: Conducting routine and surveillance visits to ensure all processes are running according to defined standards. Training and Capacity Building: Organizing training programs for healthcare providers and other stakeholders to enhance their understanding and implementation of the scheme. Qualifications and Experience: Essential: A bachelor's degree in medicine (MBBS), MBA in healthcare, Master of Health/Hospital Administration, or Master of Public Health. Essential: At least 2 years of experience in implementing a government health insurance program, the insurance industry, or with a TPA. In essence, a TPA in Ayushman Bharat plays a crucial role in the effective implementation and management of the scheme at the district level, ensuring that beneficiaries have access to quality healthcare services and that the program operates efficiently and transparently.

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 mail id - varsha.kumari@mediassist.in Thanks & Regards Email: varsha.kumari@mediassist.in

Policy Administration & Payouts Disbursements Endorsements Death Claims TPA(Third Party Administrator)

Job Title: Assistant Manager Vendor Management & MIS Experience Required: 5-7 years Job Description: We are looking for a skilled and experienced professional specializing in Vendor Management and MIS management. The ideal candidate will be responsible for overseeing the end-to-end Vendor Management process of health claim investigations, ensuring accurate data management, timely reporting and effective coordination to drive operational efficiency and service quality. Key Responsibilities: Manage the end-to-end vendor management process across PAN India, including on-boarding, billing, performance reviews and Vendor complaint resolution. Monitor and share monthly performance metrics of vendors, including Turnaround Time (TAT), quality scores, and hit ratios. Handle monthly vendor billing and invoice coordination, ensuring timely processing in collaboration with vendors and the Finance team. Regularly monitor and implement penalties and rewards based on vendor performance. Manage vendor complaint resolution by seeking explanations, conducting reviews, and initiating disciplinary actions when necessary. Ensure timely sharing of allocation MIS reports (including costing and projections) for management review. Oversee on-boarding of new vendors with thorough background verification. Maintain detailed tracking of costs associated with allocations, re-allocations, and withdrawals. Monitor and track daily allocation costs to identify variances or trends. Conduct regular audits of vendor billing to address issues such as excess payments, duplicate payments or unallocated case payments. Qualifications and Skills: Graduation from any stream 5-7 years of experience in health claim Vendor Management/Allocation Process. Ability to analyze large volumes of allocation data, Vendor billing identify trends, and make data-driven decisions Proficiency in MS Excel (pivot tables, VLOOKUP, formulas), data visualization tools (Power BI) Strong ability to manage multiple tasks, meet deadlines, and ensure timely delivery of reports and Vendor Management. Strong knowledge of MIS, including report creation, costing analysis, projection modeling, and performance dashboards. In-depth knowledge of data preparation, reconciliation techniques and Vendor allocation methodologies across a large geographic area (PAN India)

Inpatient/Outpatient Billing. Overseas/Corporate/Insured/TPA billing. Payment Tracking. Bed Management. TPA files follow-up and closure. Tracking of discounts/Cancelled bills/refunds/free bills/posting of packages. Service Recovery in the billing Area. Training of the HIS modules in billing with the power users.

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

Timings - 10 am - 7 pm. Monday to Saturday Communication - Fluency in speaking and email/whatsapp comms. Verbal proficiency in English and Hindi mandatory. Comms expectation - Interaction with Customers and Partners (TPA/insurers) Required Candidate profile Kindly share the profiles from Indian Insurance background. Preferred TPA - Mediassist, Vidal Health, FHPL, Paramount,MD india Preferred insurers - Acko, Digit, Care, ICICI Role type - claim handler

*2-4 years exp. in Indian Insurance end-to-end group medical claims, *Resolved queries via Freshchat/Freshdesk (Customer Support) *Policy Document assessments *Stakeholders Mgmt., Collaboration & led escalations *Email/WhatsApp comms. Required Candidate profile *2-4 years exp. in Indian Insurance claims processing, CRM/Servicing/Claims handler roles in Insurer /TPA. *Graduate in healthcare, insurance *Verbal proficiency in English & Hindi must.

Trainer - TPA Content Creation & Delivery Position Overview: We are looking for a Trainer responsible for creating content, delivering training, and updating training materials for our TPA operations team. The ideal candidate will have experience in training staff within the insurance or healthcare sector, specifically around TPA services and CMS guidelines. This role will focus on developing and maintaining training materials that ensure employees are well-equipped to manage back-office functions such as claims processing, enrollment, disenrollment, and other TPA services in compliance with regulatory standards. Key Responsibilities: Content Creation : Develop and create comprehensive training materials for TPA services, including training manuals, presentations, and eLearning modules. Ensure training content aligns with CMS guidelines and includes industry best practices for handling claims, enrollments, and provider payment processes. Customize content to meet the unique needs of onshore and offshore teams, ensuring relevance and accessibility for all learners. Training Delivery : Facilitate in-person and virtual training sessions for new hires & existing employees in claims adjudication, member enrollment, customer service, and regulatory compliance. Deliver classroom-based training, workshops, and webinars, ensuring interactive and engaging learning experiences. Conduct refresher training sessions to ensure ongoing knowledge retention and skill enhancement. Upkeep and Updating of Training Content : Regularly update training materials to reflect changes in CMS regulations, new process improvements, and evolving client needs. Monitor training effectiveness through feedback surveys, assessments, and performance tracking, and make adjustments as needed. Collaborate with subject matter experts (SMEs) and leadership to ensure training content remains current and relevant. Compliance and Certification : Ensure that training materials and programs comply with industry standards, including HIPAA, SOC 2, and CMS requirements. Develop and track training certifications for staff to ensure they meet regulatory and operational standards. Continuous Improvement : Collect and analyze training feedback to improve training delivery and effectiveness. Recommend and implement process improvements in training programs to enhance engagement, retention, and service quality. Required Qualifications: Bachelor s degree in Education, Training, Business Administration, or a related field. 5+ years of experience in training or learning and development, with a focus on TPA services or healthcare. Strong understanding of CMS regulations, claims processing, and TPA back-office operations. Experience in creating and delivering interactive training programs using modern learning technologies (e.g., LMS, eLearning platforms). Excellent presentation and facilitation skills, with the ability to engage and motivate learners. Strong communication and interpersonal skills for collaborating with teams and stakeholders. Preferred Qualifications: Certification in Instructional Design or Training Delivery Experience with virtual training tools Knowledge of adult learning principles and learning needs analysis. Key Competencies: Content Development: Strong skills in developing clear, effective, and engaging training materials. Leadership and Facilitation: Proven ability to lead and facilitate training sessions effectively. Regulatory Knowledge: Deep understanding of CMS guidelines and industry standards related to TPA services. Continuous Improvement: Focused on enhancing training programs to improve learner outcomes and operational efficiency. Analytical Thinking: Ability to assess training needs, collect feedback, and make data-driven decisions for content improvement.