406 Tpa Jobs - Page 9

RESPONSIBILITIES *Responding to Customers' Needs. ~Keeping an Eye on Trends and Monitoring Competition. *Communicating work and brand values with Marketing Team. *Developing a Growth Strategy.

Job Summary: We're seeking an experienced Risk and Compliance Executive responsible for vendor management, risk mitigation, business continuity planning, and client-related compliance activities . The ideal candidate will have a strong background in risk management, compliance, and contract administration within a corporate environment. Key Responsibilities: Audits and Risk Management : Plan and execute internal and external audits to ensure compliance with regulations and company policies. Manage and maintain comprehensive risk registers, and develop and implement robust risk mitigation strategies. Business Continuity Planning (BCP) : Assist in maintaining and testing BCP documentation, ensuring it aligns with industry best practices and regulatory requirements. Client Escalation Management : Assist in managing client escalations and provide closure through data/trend analysis for client compliance concerns. Ensure timely and effective resolution of escalated issues. Legal and Regulatory Compliance : Maintain and update the legal register, tracking all relevant laws and regulations. Monitor changes in legal and regulatory landscapes that may impact the business. Third-Party Assessment (TPA) : Manage the completion of client-initiated TPA processes. Coordinate with internal teams to gather required information and documentation, ensuring timely and accurate submission of TPA responses. Contract Adherence : Collaborate with legal and business units to address any contract-related issues. Enterprise Risk Register : Maintain a comprehensive enterprise-wide risk register, including regular risk identification, assessment, and prioritization across all departments. Coordinate with risk owners for timely updates, monitor mitigation strategies, track changes in risk profiles and control effectiveness. Generate risk reports for senior management, analyze data for trends, and utilize insights to support strategic decision-making and compliance efforts. Vendor Management : Monitor contract adherence for facility management vendors, ensuring services are delivered per agreed terms and specifications. Monitor and enforce compliance with legal obligations, health and safety standards, and specific legal clauses in vendor agreements. Conduct regular audits to verify accuracy, timeliness, and alignment with contractual terms and service delivery. Conduct regular vendor performance reviews and risk assessments. Qualifications: Education : Bachelor's degree in any stream. Experience : 3 to 4 years of relevant experience . Knowledge : Strong knowledge of relevant industry regulations and compliance standards . Experience in vendor management and contract administration . Proven track record in managing complex audits and risk assessment processes . Experience in developing and implementing business continuity plans . Collaboration : Ability to work effectively with senior management and cross-functional teams. Key Competencies: Regional Expertise : Strong knowledge of APAC/EMEA regulations . Industry Exposure : Facility Management experience is an added advantage; exposure to the facility management business is a plus. Strategic & Detail-Oriented : Strategic thinking and decision-making capabilities, coupled with excellent attention to detail and accuracy. Interpersonal Skills : Negotiation and conflict resolution skills. Leadership & Adaptability : Strong change management skills, leadership and team management abilities, adaptability, and flexibility.

Role & responsibilities To greet incoming patients or their representatives and to record complete information required for processing cashless facility. To hand over Pre-Auth form to patient and explain the procedure in detail. To process Initial approval, interim bill and final enhancement and co-ordinate with billing. To answer questions and to provide information directly to the person or on the telephone. For eg.Explaning Policy terms and conditions and hospital Policy regarding payment of bills. To prepare and maintain data of patients availing cashless facility and status, check payable report. To explain hospital regulations to patients, concerning Insurance process and discharge formalities. Preferred candidate profile B.Com with 1-5 years of revelant experience

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. Astha Saklani 7087994355 HRD

Vadamalayan Hospitals is looking for Claims Executive to join our dynamic team and embark on a rewarding career journey As a Claims Executive, you will be responsible for processing insurance claims and ensuring timely and accurate claim settlements Receiving and reviewing insurance claims from policyholdersVerifying policy coverage and investigating the claim to determine its validityKnowledge of insurance policies and regulationsStrong analytical and problem-solving skillsExcellent communication and interpersonal skills

Role & responsibilities To supervise all billing transactions on a day to day basis, monitor the correct processing of bill to patients and resolve/convince patients for any queries related to billing process or department. Reconciliation of cash and cheque transactions Receiving the outstanding payment report and following it up with concern departments and stakeholders Analysis of refund cases and giving necessary approvals Team meeting with IP billing and emergency on a daily basis Making floor visits along with Medical Transcriptionist. Handling grievances of patients and resolving them in a timely manner Imparting software training to team and new joiner. Attending to queries and grievances of team and conducting team meeting regularly for smooth functioning of department Preparation of MIS on a monthly basis Visiting doctor payments on a weekly basis Assuring timely payment to doctor references. Escalating billing issues to Accounts head and to the management Monitoring the billing transactions and activities at the billing desk Resolving queries related to any process of billing Assuring the clearance of all outstanding payments Checking the record maintenance of patient data Monitoring the proper handling of cash Resolving cash discrepancies arising on a day to day basis Auditing of concessions, cash statements and patient

Objective / Purpose NA About Us NA Roles & Responsibilities Underwriting grievances/ queries to be resolved in co-ordination with TPA Branch queries/Sales queries to be resolved pertaining to medicals Follow up with CMO for decision and pushing cases to resolve bucket Stop/Cancellation data maintenance on daily basis and send mail to TPA accordingly Follow up with TPA for additional medicals fixing Ensure timely and accurate billing of TPAs / Data maintenance for the same. Medical quality control/ Mystery shopping & checks Educational Qualification Any Graduate Experience 5 to 8 Years Competencies Skills Minimum 3 years of Underwriting experience. Thorough Knowledge of Underwriting principle and process, Experience in Excel / MIS prepartion preferred Title: Senior Executive - Underwriting

Objective / Purpose NA About Us NA Roles & Responsibilities Underwriting grievances/ queries to be resolved in co-ordination with TPA Branch queries/Sales queries to be resolved pertaining to medicals Follow up with CMO for decision and pushing cases to resolve bucket Stop/Cancellation data maintenance on daily basis and send mail to TPA accordingly Follow up with TPA for additional medicals fixing Ensure timely and accurate billing of TPAs / Data maintenance for the same. Medical quality control/ Mystery shopping & checks Educational Qualification Any Graduate Experience 8 to 10 Years Competencies Skills Minimum 4 years of Underwriting experience. Thorough Knowledge of Underwriting principle and process, Experience in Excel / MIS prepartion preferred Title: Deputy Manager - Underwriting

Responsibilities: * Manage claims from intake to settlement. * Adjudicate medical necessity & settle claims fairly. * Ensure timely claim payment & employer satisfaction. * Process mediclaim & health insurance claims accurately.

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years Language - Ability: English(Domestic) - Intermediate 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 perform under pressureAbility to work well in a teamAdaptable and flexibleCommitment to qualityAccount Management 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

Key Responsibilities: Handle end-to-end reimbursement and cashless claims for corporate clients' employees and dependents. Scrutinize claim documents for completeness, medical validity, and compliance with policy terms. Coordinate with empaneled hospitals, insured members, and insurance companies for claim clarification, queries, and approvals. Maintain TAT and SLA commitments for smooth and timely processing. Ensure compliance with IRDAI guidelines and internal company SOPs. Update and manage claims data in the internal system accurately. Prepare and share MIS reports with internal stakeholders and corporate clients. Manage escalated and high-value claims with detailed attention and resolution

We are seeking a dedicated and detail-oriented Patient Finance Counsellor to join our hospitals administrative team. This critical role involves guiding patients and their families through the financial aspects of their treatment, ensuring transparency and understanding regarding costs, insurance, and payment options. The successful candidate will excel in admission counselling related to finance, demonstrate strong coordination skills with various departments, and possess an unwavering commitment to compassionate patient care while managing all finance -related inquiries. If you have a background in healthcare finance or counselling and are passionate about supporting patients through their healthcare journey, we encourage your application. Financial Admission Counselling: Conduct comprehensive admission counselling specifically focused on the financial aspects of patient treatment plans. Clearly explain estimated costs of procedures, hospital stays, consultations, and ancillary services to patients and their families. Educate patients on various payment options, including self-pay, insurance coverage (private and government schemes), and installment plans. Assist patients in understanding their insurance benefits, deductibles, co-pays, and out-of-pocket expenses. Financial Coordination & Management: Serve as the primary point of contact for all finance -related inquiries from patients and their families from admission through discharge. Coordinate closely with the billing department, insurance desk, and TPA (Third Party Administrator) teams to ensure accurate billing, claims submission, and pre-authorization processes. Facilitate the collection of initial deposits, co-payments, and outstanding balances in accordance with hospital policies. Provide estimates of charges for planned admissions and procedures, and update patients on changes in their billing status. Manage patient financial records, ensuring accuracy, confidentiality, and compliance with hospital regulations. Patient Care & Support: Exhibit exceptional patient care by addressing financial concerns with empathy, sensitivity, and clear communication. Help patients navigate complex insurance policies and resolve discrepancies in billing or coverage. Liaise with social workers or patient advocates when necessary to identify financial assistance programs or charitable options for needy patients. Ensure all financial communication maintains transparency and builds trust with patients and their families. Inter-departmental Coordination: Collaborate effectively with the admissions team to integrate financial counselling into the overall admission process. Work with clinical departments to understand the scope of treatment and its financial implications for patients. Participate in departmental meetings and provide feedback on financial counselling processes to improve efficiency and patient satisfaction.

MBA/MHA Hospital and Healthcare management with 1 to 3 years of experience or any graduate with experience in hospital billing department with 3 to 4 years of experience. Experience : Minimum 2 years of Clinical experience with one year of experience working in Hospital billing department or 2-4 years of experience in Hospital Management. 3-year fixed term contract Roles and Responsibilities: Planning of the teaching programme including an orientation programme in consultation with the HOD Academics. Planning for students Practical experience, ward assignments and trainings in consultation with the HOD Academics. Planning of curriculum with the cooperation and collaboration of the HOD Academics Competent in Handling Hospital Front desk in terms of Patient Appointments and queries. Preferred Team handling exposure of patient care coordinators. Inbuilt empathy towards the patient and patient relatives. Knowledge of Hospital Billing components for IPD and OPD. Experience of handling TPA coordination and TPA queries for cashless facility. Knowledge of Hospital Billing and tax law applicable to the hospital or healthcare industry. Competent in Professional English (written and spoken) in terms of different professional operational scenarios. Proficient in training to provide outstanding services and ensure customer satisfaction. To educate students on how to address customer concerns and complaints promptly and professionally. To respond to customer needs and requests in a timely manner. Competent in teaching telephone etiquettes and resolve queries. To train to resolve billing concerns of customers and handle card and cash transactions. Knowledge of healthcare operations and quality parameters. Excellent communication, IT Skills and people skills. Desired Skill Sets: Excellent written and verbal communication skills. Good computer skills. Broad-minded personality, which is open and curious about new teaching methods, responsible, reliable, team-minded and resilient. Attention to detail, empathy and inclusive approach. Request you to please share your updated CV at

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

To co-ordinate with cashless patients, Insurance companies and corporate for smooth functioning of cashless treatment provided to the patient. To send the pre-authorization forms to the concerned TPAs and to follow-up till receipt of initial approval

About Us: Medi Assist is Indias 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. Qualification: BAMS BHMS Work from office only Address: 4th floor, AARPEE Chambers, Off Andheri-Kurla Road Industrial Estate Marol, Andheri East, , Marol Cooperative Next To Times Square, Shagbaug, Gamdevi, Marol, Mumbai, Maharashtra 400059 Interested candidates can share their CVs to: Email: dona.antony@mediassist.in WhatsApp: 9632777628

Key Responsibilities: *Knowledge 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.

Skill required: Retirement Solutions - Customer Service Designation: Customer Service Associate Qualifications: Any Graduation Years of Experience: 1 to 3 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 1+ years of experience in US Retirement Services domain Defined Contributions Managing Institutional contributions/ payroll contributions Alternatively, 1+ years experience in payroll processing (preferred)Remittance file management, Incoming contribution management, Payroll file management, Suspense resolution, Client communication (email and phone), Lockbox managementProcess incoming contributions for assigned clients\transactions. Includes;oManual formatting nonstandard payroll files received (large data), excellent excel skills, data formatting, text to column de-limit. Analytical skills to separate out various contribution sources oSuspense resolution, research and match contributions that dont auto match to a sourceoResolve errors from a remittance file and review reports prior to postingoIndividual contributions - Create deposit TSA/ TPA others, based on contribution received from Lockbox, Wire, ACH, ChequesCommunication:Work with plan administrators and Customer Service Management via email and phone for sending Good Order Notices (GON) and or payroll issues oresolve suspense contributionsEnsures all items are processed and\or resolved in a time. Supports business in audit processes.Complies with all client policies, procedures, and Federal/State/Local regulations and escalates issues to the management.Perform research on all processing irregularities and drive issues to resolutionStrict adherence to non-disclosure of client information by preserving client confidentiality.Research on any queries/ requests sent by the Business Partners/Client Support Teams and replying the same with stipulated time Take active participation in process improvements and automation opportunities.Ensure Quality Control standards that have been set are adhered to. What are we looking for Excellent organizational skills with ability identify and prioritize high value/ aging transactions.Completing assigned responsibilities and projects within timelines apart from managing daily BAU. Roles and Responsibilities: Bachelors degreeExperience in the US retirement industry Experience using Omni or any other Record Keeping platform (preferred)Open core Night shifts based on business requirementsGood verbal & written communication skills in EnglishGood typing skill and attention to detail.Good time management skillsAbility work independently Qualification Any Graduation

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. Qualification: BAMS BHMS Work from office only Interested candidates can send their CV to varsha.kumari@mediassist.in

Job Description: Skills Required: Strong leadership, team management skills with Excellent communication and interpersonal skills Comprehensive understanding of hospital admission processes and billing systems Customer service oriented with problem-solving capabilities Ensuring accurate billing for services provided to inpatient (hospitalized) patients, including room charges, medical procedures, medications, and consultations. Leading and managing the team responsible for processing and generating bills for inpatient services. Collaborating with other departments like clinical, pharmacy, and insurance for timely and accurate billing. Overseeing day-to-day administration, directing and controlling of the IPD operations. Ensuring close adherence to prescribed Standard Operating Procedures (SOPs) in all functional areas. Organizing regular training inputs and organizing feedback sessions from Staff and Customers. Monitoring customer feedback on a day-to-day basis - acknowledges and take corrective action, wherever required. Interacting with Consultants in IPD and catering to their requirements. Oversee and streamline billing process and for the timely submission of medical claims to insurance companies Cross Checking of patients bills i.e. balance and final respectively. Taking any confirmation with IPA and coordinating with TPA for any deficiency in getting approval. Manages billing system updates and providing patient financial counseling Going over insurance pre-authorizations and verifications and tracking payment and payment plans. Educating the patients about their rights and responsibilities. To ensure timely and accurate compliance with the standards laid down under ISO for the departmental function. To handle inter and intra departmental coordination for smooth discharge. Preparing TPA approval as per given clauses and coordinating with Cash/ Corporate bill on daily basis. Authentication of documents CGHS/ PSU and same dispatch to concern for final payment. Post discharge checking of CGHS/ TPA bills. To ensure timely action on patient queries related to billing. To follow Cash / Credit / Corporate billing / discount instructions. To ensure accurate and timely Billing. Maintaining register for discharge flow. Checking of referral, approval and mandatory requirements of institutions. Package mapping during night hours. Updating OT sheets and assigning packages of Cath/ OT. Special vigil on international patient billing. To be well groomed, punctual & adhere to company policies and practices. To effectively utilize Hospital Information System and other software provided. To comply with the service quality process, environmental & occupational issues & policies of the respective area.

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.

Hurry up Authentic Healthcare is hiring Medical officers Non clinical job AT Noida, HYD , Bangalore Location Role/Position: Permanent Experience: 1 to 2 yrs in TPA or clinical Education: BPT, MPT,BDS, BAMS, BHMS Shifts: Day shift work from office

Job Description (IFD) Communicating with clients and understanding the investigation requirements. • Meeting with clients to discuss the nature of the investigation. • Conducting field investigations on appointed cases, insurance claims, or client requests. • Conducting in-depth research on various appointed cases. • Decide the extent and validity of a claim, and in so doing, prevent fraudulent claims by determining the claim's authenticity. • Gathering and analyzing evidence reports. • Conducting photographic and audio surveillance to gather evidence • Reviewing and solving cases by authenticating insurance claims. • Coordinating with agents to understand insurance claims matters. • Answering to specific trigger in reports. • Manage multiple cases with confidence and accuracy and respond well to working to meet targets and tight deadlines. • Prepare reports, maintain records and keep track of evidence trails. Address - MD India Health Insurance TPA Pvt. Ltd. H.No.6-3-883/A/1 #: 201, 2nd Floor, imperial Plaza, Beside Topaz Building, Panjgutta, Hyderabad - 500082. Contact Number - 7030949730 ( Neha Nanoti )

Adani Hospitals is looking for 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 Clinical Medical Officer MBBS

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.