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0 - 5 years

1 - 5 Lacs

Pune

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Urgent requirement for BHMS/BAMS/BDS/MBBS-Pune (Vadgaonsheri) Freshers/candidate with clinical or TPA experience Interested candidates can call on 7391042258 (Sneha- HR department) or share their updated resumes to recruitment@mdindia.com Roles and responsibilities: Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Required Candidate profile: BAMS / BHMS / BDS/ MBBS graduate. Good Medical & basic computer knowledge Should have completed internship (Provisional /Permanent Registration number is mandatory) Freshers can also apply. Work from office . Interview Timings-11am To 5pm(Monday To Saturday) Venue Details: MDIndia Health Insurance TPA Pvt. Ltd. S. No. 46/1, E-space, A-2 Building, 4th floor, Pune Nagar Road, Vadgaonsheri, Pune 411014

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2 - 7 years

4 - 8 Lacs

Mumbai Suburbs, Mumbai (All Areas)

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We are hiring for Network Manager Job Title: Network Manager (West Zone) Location: Mumbai - Sakinaka Working Days: Monday to Saturday (Any 2 Saturdays off in a month) Shift Timings: 10:00 AM to 7:00 PM or 10:30 AM to 7:30 PM Job Summary: We are looking for a high-energy, mature individual who excels in Business Development , Relationship Building , and is process-oriented to independently handle the West Zone . The ideal candidate should be capable of driving sales, managing relationships, and overseeing process integration with medical providers. This role also involves working closely with Operations/IT teams to ensure smooth integration after contracts are signed with medical providers. ts. Key Responsibilities: Drive network empanelment with hospitals, diagnostic centers, and wellness networks in the West Zone. Build and maintain strong relationships with medical providers. Lead negotiations and finalize service agreements. Maintain and update the Medical Network database. Manage network empanelment for corporate and retail healthcare services. Occasional travel within the West Zone. Preferred Skills & Qualifications: Experience in business development within healthcare or similar sectors. Strong relationship-building and negotiation skills. Technically proficient with IT systems. Willing to travel as needed. Why Join Us? Work with a dynamic and growing team in the healthcare sector. Opportunity to independently manage the West Zone and have a direct impact on business growth. Competitive compensation package with opportunities for growth. Education: Any Graduate or Postgraduate Email your CV at naina@mumbairozgaar.com Call me at 7039628121

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1 - 3 years

3 - 4 Lacs

Gurgaon

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Interested candidate can share their CV at Hr82@miracleshealth.com or call at 9911652651

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3 - 7 years

15 - 20 Lacs

Gurgaon

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The associate will be responsible for leading and managing independently Operational Services to Sales Leaders and help drive NCVI (Net Contract Value Increase) by executing key processes and improving Territory Strategy for a Pod. Independently drive and partner with TPA Stakeholders to help Sales Leaders take informed decisions in incremental Sales force and building optimal territories. Clients Service: Provide support to Gartner Sales Leaders Engage verbally and in writing with assigned Sales regions to provide timely and accurate resolution Work on ad-hoc and regular operational projects with minimal guidance Manage and resolve support requests from internal clients within service level agreements. Engage with Sales Leaders and partners with members across functions to deliver value Partner within and across teams to Identify gaps, problem solve and improve Seller productivity and experience Conduct data analysis and support reporting needs Ensure data integrity by identifying discrepancies and updating datasets regularly. Manage data tools and internal applications including Anaplan, Excel, Power BI, CRM, etc. Successfully drive high complexity projects with minimal guidance Gain strong understanding of internal systems and processes such as Account Moves Process guidelines and Rules of Engagement (RoE) Mentor and train other team members on processes/tools Execute on business-critical sales operations & provide service support for core TP&A processes which include: Correct account alignment: Ensuring right Salesperson is assigned to correct accounts Efficient new hire intake process: Ensuring new to role sales associates have a robust territory as soon as they become quota eligible. Personnel changes: Ensuring our internal processes and systems are set up when we have critical changes in our sale personnel. E.g., when sales associate join or depart the firm, when they have changes in their territories, etc. Assist with transition and implementation of new processes. Own and drive execution of assigned workstreams independently. What you ll need: Bachelors degree, preferably in STEM discipline with 3 years of relevant experience in client service and/or service operations/delivery role Strong Microsoft office skills, especially Excel and Power Point, knowledge of VBA/Macros and Power BI is a plus. Experience in working with multiple stakeholders across geographies with changing requirements. Problem-Solving ability breaks down problems and considers solutions, comfortable with quantitative analysis. Good Communication skills with a strong sense of ownership and is seen as trusted business advisor by stakeholders Thoughtful, coachable & driven individual, respectfully challenges the status quo and quickly absorbs feedback Stakeholder Management - works effectively with stakeholders/partners/teams; builds / maintains good relationships. High sense of urgency and attention to detail Ability to analyze and improve operational processes and services. Good organizational and time management skills. What you will get: Competitive salary, generous paid time off policy, charity match program Group Medical Insurance, Parental Leave, Employee Assistance Program (EAP)and more Collaborative, team-oriented culture that embraces diversity Professional development and unlimited growth opportunities

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10 - 20 years

25 - 35 Lacs

Chennai, Bengaluru, Hyderabad

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Job Title: Head of Sales & Operations (Corporate Business) Job Summary: The Head of Sales & Operations - South will be responsible for leading the sales and operational functions of the Corporate business. This role involves revenue growth, client retention, strategic planning, business development, and ensuring operational efficiency while maintaining financial discipline. The ideal candidate will have extensive experience in corporate sales, business development, and operational strategy with a strong focus on P&L management. Key Responsibilities: Revenue Growth & Client Management: Drive revenue growth and maintain relationships with existing clients. Monitor departmental income and optimize the P&L by balancing revenue and expense control. Develop strategies to expand the client base and create a strong sales pipeline to meet corporate revenue targets. Achieve monthly, quarterly, and yearly revenue targets by acquiring new corporate clients. Retain existing clients while upselling and cross-selling new services. Business Development & Strategic Planning: Establish strategic relationships with industrial partners and key clients. Develop, review, and implement the operations divisions strategy. Ensure strategic objectives are understood and executed by regional and project heads. Participate in tenders/RFPs, contract renewals, and compliance management. Conduct market research to map future project prospects. Service Offerings: Oversee the provision of services such as dedicated stationed ambulances, Ambulance On-Call, Medical Room (Doctor & Nurse On-Site), Occupational Health Centre (OHC) Services, Mobile Medical Units (MMU), Wellness Programs, and Health Check-ups, Preventive Care. Operations & Cross-Functional Coordination: Ensure smooth start-up and execution of new projects by coordinating with different departments. Work with regional/project heads to ensure project plans align with budget and quality standards. Implement and manage an effective system of financial and non-financial controls throughout operations. Billing, Payment Recovery & Compliance: Ensure timely billing and systematic follow-up for 100% payment collection within due dates. Manage compliance-related client requirements, contract renewals, and addendums. Travel & Reporting: Travel extensively to meet corporate clients, attend meetings, prepare proposals and presentations. Submit reports and briefings to senior management as required. Qualifications & Skills: Bachelor's/Masters degree in Business Administration, Sales, or a related field. Experience in HEALTHCARE business development is MUST Strong leadership, strategic planning, and financial acumen. Proven track record in corporate sales, revenue growth, and client management. Excellent communication, negotiation, and problem-solving skills. Ability to manage cross-functional teams and ensure service excellence. Willingness to travel for business engagements. Interested candidates can share resume on email - sakshi.mittal@zenplus.in or WhatsApp on 7777069177

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1 - 3 years

3 - 4 Lacs

Bengaluru

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Job Title : Doctor with TPA/Insurance Experience (BHMS/BAMS/BDS/MBBS) Experience : 1 Year (BHMS/BAMS/BDS preferred; MBBS advantageous) Notice Period: Immediate Joiners or Maximum 1 Month Job Location: Whitefield,Bangalore Interview Mode: Face-to-Face Key Responsibilities: Handle tasks related to Third-Party Administrator (TPA) operations or insurance processes. Conduct and review medical evaluations in alignment with policy guidelines. Collaborate with teams to resolve medical claims and documentation efficiently Support in implementing healthcare and insurance workflows Desired Candidate Profile: BHMS/BAMS/BDS candidates with at least 1 year of experience. MBBS-qualified professionals are highly preferred Proven experience in TPA or insurance-related roles is essential. Strong knowledge of medical terminology and insurance processes. Excellent communication and problem-solving skills. Why Join Us? Competitive salary packages. Opportunity to work with a dynamic and supportive team. Exposure to healthcare and insurance industry operations.

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1 - 3 years

2 - 4 Lacs

Bengaluru

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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 Thanks & Regards Hariprasad

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5 - 6 years

8 - 9 Lacs

Hyderabad

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To serve as the internal point of contact for any questions about insurance benefits that our employees may have. Conduct weekly check-ins with the broker or TPA to monitor employee claims and ensure that all claims are processed within predetermined timeframes. During induction, walk new hires through the various benefits administration procedures. Collaborate with and monitor the performance of benefits vendors to ensure the delivery of high-quality services. Engage with employees who have escalated their insurance claims, address their questions, and collaborate with a broker or TPA and your manager to find a solution Administer leave system and manage leave administration processes, ensuring compliance with local regulations and internal policies. Work closely with Compensation Benefits teams and benefit vendors to streamline operations and enhance efficiency. Conduct regular audits and checks to assess the accuracy and effectiveness of benefits operations. Other Payroll administration work as an when required will have to be supported. Participate in other required HR Operations projects and initiatives to drive improvements and organizational goals. Qualifications : Minimum Bachelors degree required A minimum of 5 years of experience in benefits administration and leave management. Strong knowledge of insurance products, flexible benefits, and local regulations in India. Demonstrated sense of urgency and commitment to timely project completion. Experience with Workday is preferred Excellent communication and interpersonal skills, with the ability to interact effectively across various levels of the organization. Ability to work both independently and collaboratively within a team environment. Strong analytical and problem-solving skills, with a focus on detail. Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint)

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7 - 12 years

4 - 9 Lacs

Kanpur

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JOB DESCRIPTION IP Billing Job Responsibilities To direct, coordinate & supervise billing department. Develop/ Revise department specific policies, protocols & processes in consultation with Finance Controller for smooth & efficient working of the departments. Ensure implementation & adherence of above mentioned policies, protocols & processes. Ensure availability and optimum utilization of resources (equipments, manpower & other materials) Ensure HIS is being timely updated for patients billing status (pre-auth /payment status). Responsible for checking & ensuring accuracy & completeness of all bills before patients are discharged. Ensure medical data is secure, accessible and accurate for billing purposes. Ensure that patients attendant are timely informed and counselled about plan of treatment, estimated bill, Advance to be deposited, status of pre-authorisation etc to increase customer satisfaction. Direct and guide billing executives in answering queries raised by TPA, to ensure approval of maximum possible amount. Ensure deposits are received within the defined timelines. Resolve patients complaint regarding billing errors, discounts, Authorisation from TPA etc. To authorise discounts to patients, as per the laid down policy. Ensures completion of billing formalities of discharged patient within the defined TAT. Should keep the team members updated of any change, in terms & conditions of contract with TPA/PSU/Corporate, any new empanelment, change in tariff etc. Responsible for the continuous assessment and improvement of the quality of services. Maximize customer satisfaction (internal as well as external) by developing cordial work environment with other departments and smooth delivery of services. Assist Finance Controller in developing operating & capital budget of the departments and ensure adherence to the budget. Provide daily & monthly reports as per the given format to reporting Manager. Work in close coordination with HR Department for: Training of employees Control /Reduction in attrition Reduction in over time Key Performance Indicators Adherence to policies & protocols Customer Satisfaction Index Patients Attendant Complaints Adherence to TAT (Receipt of Activity Sheet from Pharmacy to the Final Bill) Billing Errors Adherence to operational budget Timely submission of reports Training sessions of personnel Reduction in Overtime Reduction in attrition

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0 - 5 years

3 - 4 Lacs

Mumbai

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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 : Sarika.pallap@mediassist.in Thanks & Regards Sarika Pallap - 8951865563

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1 - 5 years

3 - 6 Lacs

Delhi NCR, Hyderabad, Noida

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ensure a settlement ratio of 100% by preventing unwarranted queries, and going for claim decision as much as possible. Claims should be processed wherever deduct and pay is applicable. Claims Processing

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1 - 4 years

2 - 4 Lacs

Bengaluru

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Greetings from medi Assist TPA Health insurance company!! We have uregent requirement in CRM with health insurance or hospital background Job description Follow up with insurers for clearing the external error logs (beneficiaries not updated in the policy) and ensure beneficiary updated in the policy and the claim is cleared Follow up for insurance claim number from the insurance office and ensure float is raised and follow up with accounts team for the UTR (settlement) details Follow up with insurer for Void payments. Coordinate with insurer and customer to resolve all concerns related to payments, short payments and all queries pertaining to claims, enrollment, etc. Responsible for monitoring & responding to all queries raised to a particular mail ID assigned for a specific customer/s Interested candidate can drop there resumes on my whatsapp no - 9035613355 Thanks & Regards Hariprasad Email : hariprasad.m@mediassist.in

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3 - 8 years

4 - 6 Lacs

Bengaluru, Greater Noida

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Greetings from Medi Assist!! Urgent Job requirement for Assistant Manager in Bangalore & Noida for CRM Job description: Assistant Manager-Account Management Location : Bangalore & Noida Roles and Responsibilities Maintain relationship with insurers. Manage their queries and resolve them satisfactorily. Meet important clients regularly. Check status of clients, work with internal team members to clear outstanding and pending claims Interact with internal & external stake holders to ensure customer queries are addressed in a timely manner Encourage clients to submit the required pending documents to reprocess the claims. Resolve customer queries and grievances with reasonable explanation. Handling inbound and outbound calls, managing escalations Relevant Experience : 5-6 years in a customer facing/customer support role which involves finding solutions. Health Insurance/TPA background preferred Thanks & Regards Hariprasad Email id : hariprasad.m@mediassist.in

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7 - 12 years

35 - 90 Lacs

Chennai, Bengaluru, Kolkata

Hybrid

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Establish systems and processes to ensure sustainable levels of performance. Monitor transactions to improve performance. Report/analyze performance using appropriate tools/mechanisms and take corrective action where necessary. Appropriate Corrective

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1 - 6 years

0 - 1 Lacs

Hyderabad

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Urgent Hiring for IP Billing & Financial Counselor Designation- Executive/Sr .Executive Shifts- Rotational Shifts Gender- Male / Female Interested candidates can directly walk in for interview -1 floor HR Dept ,KIMS Hospitals Gachibowli ,or share your Cv to 9030420202

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0 - 5 years

3 - 5 Lacs

Mumbai

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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 Thanks & Regards Varsha Kumari Email: varsha.kumari@mediassist.in

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1 - 6 years

0 - 3 Lacs

Kolkata

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Graduate in BHMS/BAMS/Pharma D/BPT/MPT/BDS Prior experience in domestic claims processing Should be able to provide support in staggered shifts Should be ready to work on weekends per the roster

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5 - 8 years

6 - 9 Lacs

Mumbai

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Overall Supervision and functioning of the department to deal with billing clarifications with respect to Cash, TPA, corporate. Ensure staff training in billing & Billing audit Policy. Improve processes to achieve quick and error free billing. Ensure all the services provided in hospital are mapped in HIS with their Tarif as per bed category and payer category . Ensure that the admission deposit is collected as per policy at the time of admission Ensure that the surgeries are proceeded only after collection of OT clearance amount Ensure that the services provided to patients are posted in HIS on regular basis The respective stakeholders are informed regarding pending service posting and ensure the same is completed within 12 hours of informing Ensure the OT billing is closed within 4 hours of surgery completion. In case of items where GRN is pending, ensure that the OT billing is closed within 24 hours of surgery completion Ensure that all the patients leaves the hospital only after paying complete bill and bill closure in HIS and discharge clearance is issued to all the patients In case the service is not available in HIS and has been posted as "Unlisted services", the new service request is created as per Service Code creation SOPs. The billing manager has to ensure that no service is posted under Open billing without their approval Keep track of Open bills of discharged patients and get them closed within 24 hours In case of credit/corporate patients, the bill must be closed after receiving Final authorization from the TPA/insurance company and clearing the patient payable amount from the patient Ensure that the required Document are sent as soon as possible and any query is resolved within 24 hours Ensure the staff, clinicians and their next of kin are given discounts as per policy Authorize the discounts as per policy for cash patients and ensure that the discount remarks are entered properly in HIS Ensure the discount approvals are taken in designated forms and authorization is taken from respective authorities as per policy. The scanned copies of forms are uploaded in HIS for future reference. Authorize the bill cancellations due to billing error, admission cancellation or any other reasons. Document the same in HIS under reason for cancellation Ensure the refund is processed within 24 hours of bill cancellation Ensure that the Daily monitoring of bill status and collection of outstanding is done without failure Ensure that 100% of the bills are audited before closing the bills. In case the interim bill of patient goes beyond the estimate, ensure the staff informs the financial counsellor for re-counselling of the patient Monitor conversion against estimate provided to patients Ensure that recounselling is done to the patients whose interim bill exceeds the counselled amount and who has any deviation in treatment plan Check reasons for gap between estimates and final bill and address the issue to keep it under check as per HCG policy Increase the number of planned admissions by effectively putting in place the planning process & by identifying and rectifying the reasons for unplanned admissions Monitor the daily planned & Unplanned admission ratio & beds booked. Authorizes & Monitor upgradation/down gradation and shifting back of patients to requested category. Ensure provision of Bed & counseling upon admission in timely manner Monitor planned and unplanned discharges, adherence to discharge planning. Monitor TAT for patient discharges (Payor type wise) Improve discharges planned a day prior, Ensure non clinical discharge activities are completed on the day of planning. Ensure The responsibility includes proper Registration of the patients, capturing all the necessary details, collecting details for the admission of the patients, taking consents, overseeing patient rooms in terms of proper services and provision of services to the relatives as determined by the Organization from time to time, managing patient transfers as requested by the Clinical team and discharging the patient as per the Discharge Process.

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0 - 5 years

1 - 5 Lacs

Coimbatore

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Walk-in Drive from 1st April 2025(Tuesday) 4th April 2025(Friday) for Clinical Content Analyst at Coimbatore. Role: Clinical Content Analyst Interview Date : 1st April 2025(Tuesday) 4th April 2025(Friday) Timings : 10Am to 3Pm SPOC: Avinash Jeniga Venue: Cotiviti India Pvt Ltd India Land Tech Park, 7th Floor Tower C Saravanampatti, Keeranatham, Coimbatore TN- 641035 Eligibility Criteria: Education BHMS,BAMS,BUMS,MBBS,BPT,BDS Candidates with prior US Healthcare or Clinical experience will be preferred. Good communication skills. Candidates with corporate experience will be preferred. Good team player with strong interpersonal skills & high integrity. Ready to work from office Immediate joiner's preferred Interested and eligible candidate walk-in directly to above mentioned venue.

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2 - 4 years

2 - 4 Lacs

Ahmedabad

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Key Responsibilities: Client Servicing: Address and resolve customer queries within specified TAT (turnaround time) for seamless claim processing. Provide accurate and timely claim-related information to customers , agents broker and insurer. Coordinate with customers and agents to facilitate cashless claim settlements efficiently. Liaise with internal teams such as enrollment, account management, claims, investigation, and support teams to expedite claim resolutions. Partner with the enrollment team to register policies for cashless and reimbursement processes. Respond to incoming calls and emails from customers, broker and insurer. Track and monitor customer queries, ensuring claims are resolved efficiently, with proper follow-ups. Work with the cashless/pre-authorization team to ensure cashless approvals are granted within TAT. Clearly explain claim status, query letters, and settlement details to customers and agents. Strong knowledge of insurance claim processes (cashless and reimbursement). Proficiency in coordinating with multiple stakeholders. Customer-centric mindset with the ability to handle queries professionally. Organizational skills to track, monitor, and resolve claims effectively. Requirement Strong communication and interpersonal skills. Ability to manage multiple stakeholders and priorities. Proficiency in claims management and customer relationship processes. Hands on experience in Ms Excel, Pivotable, Advance Excel etc... Working Location: Vidal Health Insurance TPA Pvt LTD. 2nd Floor, 202, Binali Complex, Opp. Torrent Power Zonal Office, AEC, Naranpura Cross Road, Ahmedabad, Gujarat 380013 Contact Details: Email: Pratap.navane@vidalhealth.com Phone:8652886133

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0 - 2 years

1 - 3 Lacs

Warangal, Hyderabad

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We are currently hiring Medical Officers to handle the processing of cashless requests and health insurance claims for TPAs/Insurance companies and Manage volumes effectively & efficiently to maintain Turnaround time of processing cases.

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3 - 8 years

4 - 5 Lacs

Bengaluru

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Team Leader JD Responsibilities • Analyze call center data to generate valuable insights to predict customer trends. • Track key quality assurance metrics for improvement strategies. • Monitor KPIs, track quality metrics and provide regular analytics reports to upper management. • Make recommendations on process and policy improvements from reports. • Recommend call center QA software and training for customer support teams to meet and exceed customer service expectations. • Develop and improve knowledge of products and knowledge of call center performance and functional requirements. • Tech-driven solution that will enhance customer experience and reduce manual efforts from the human • System platform creation to view the information that can be communicated to the customers to avoid the errors and bring the uniformity of information across the LOB. Customer Service/Satisfaction Responsibilities • Review agents conversations across all contact touch points to measure teams performance and track customer support quality. • Contribute to call calibration sessions to evaluate agent performance. • Identify lapses in agents performance and provide constructive feedback for improvement. • Engage in customer listening to identify customer pain points and expectations. • Drive the implementation of improved customer engagement strategies to increase agents’ efficiency. • Serve as an intermediary for escalations from agents and customers. • Ensures communication is effectively delivered and appropriately addresses all customer concerns. Operational/Business Process Responsibilities • Develop process controls, standard operating procedures (SOPs), and supporting documentation for training, onboarding, and customer support. • Identify process improvement opportunities to update SOPs. • Implement and ensure compliance with the company’s policies on customer service quality. • Report support teams’ performance to supervisors and maintain monthly performance logs. • Participate in team meetings to discuss customer service trends, agent review feedback, and implementation of quality management strategies. • Provide recommendations to HR on the employment of call center agents. • Support recruiting and onboarding processes as appropriate. Interested candidates can share their CVs with varsha.kumari@mediassist.in

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0 - 5 years

2 - 7 Lacs

Jodhpur

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Roles and responsibilities: Greet and welcome guests as soon as they arrive at the office Direct visitors to the appropriate person and office Answer, screen and forward incoming phone calls Ensure reception area is tidy and presentable, with all necessary stationery and material (e.g. pens, forms and brochures) Provide basic and accurate information in-person and via phone/email Receive, sort and distribute daily mail/deliveries Perform other clerical receptionist duties such as filing, photocopying, transcribing and faxing Assist the patient in getting Cashless facility at Medipulse Upload the documents at the end of the day, do audits, follow up on Payment etc. Have extensive knowledge of Hospital Billing software. Check IPD files daily and update the HIS at the end of the day. Skill sets/Experience we require: Proven work experience as a Receptionist, Front Office Representative or similar role Proficiency in Microsoft Office Suite Hands-on experience with office equipment (e.g. fax machines and printers) Professional attitude and appearance Solid written and verbal communication skills Ability to be resourceful and proactive when issues arise Excellent organizational skills Multitasking and time-management skills, with the ability to prioritize tasks Customer service attitude

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9 - 14 years

12 - 17 Lacs

Vadodara, Ahmedabad, Rajkot

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Apollo Tele health Services is looking for Senior Medical Officer to join our dynamic team and embark on a rewarding career journey. Diagnosing and treating patients' illnesses and injuries Creating and maintaining patient medical records Prescribing medication and therapies Ordering and interpreting diagnostic tests Referring patients to specialists as needed Developing and implementing treatment plans Educating patients about their health conditions and treatment options Working closely with patients and their families, as well as other healthcare professionals

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0 - 4 years

3 - 5 Lacs

Bengaluru

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Position Description: 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. Job Description: Ensuring error free processing of Pre-Authorization 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 providers as needed and file completed precertification requests as per procedures o Interacting with providers for discharge summery etc.. as and when required. Skills and Competencies: Medical practitioner/BDS/BHMS/BAMS or equivalent qualification Ensure 100% accuracy of all the authorization approval as per the process. Any authorization not as per the limit or as per the process to be escalated to the team manager on priority. 0-3 years experience in Pre-Authorization and Claims management. Any medical opinion required from the specialist to be escalated to the specialist. Sound medical knowledge and willing to work in non clinic process. Ensuring process compliance is met as per regulatory procedures. Minimum of one year experience in handling authorization (preferred) Maintaining Daily excel maintenance for Pre auth cases received and processed. Should be willing to work in shifts as the department works on 24/7 function Solving customer queries wherever medical opinions are required and need to be address by the medical practitioner Should be willing to work from office (no WFH)Role & responsibilities Contact: HR - Swathi S Kumar Mob No: 7760595011/89518 93649 Email ID: swathi.kumar@vidalhealth.com

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