Medical Officer – TPA Claim Process
3 weeks ago
Job Title: Medical Officer – TPA Claim ProcessDepartment: TPA / Health Insurance DeskLocation: Vadodara Reporting To: TPA Manager / Operations HeadJob Summary:The Medical Officer (TPA) will be responsible for reviewing, validating, and processing insurance (TPA) claims, ensuring medical accuracy, compliance with policy terms, and timely coordination between hospital departments, doctors, and TPA representatives.Key Responsibilities:Examine and verify patients’ medical records, treatment plans, and discharge summaries for insurance claim processing.Coordinate with treating consultants to obtain medical justifications or clarifications required by the TPA.Scrutinize pre-authorization and final bill submissions as per TPA and insurance guidelines.Ensure correctness of ICD codes, procedures, and diagnosis in the claim documents.Review claim queries and prepare appropriate medical responses or justifications.Liaise with TPA coordinators, hospital billing, and admission teams to ensure smooth cashless approval and reimbursement flow.Maintain accurate claim records and ensure timely submission of documents to TPAs.Monitor and track pending and rejected claims, ensuring resolution in coordination with the TPA team.Ensure compliance with TPA policies, medical ethics, and hospital protocols.Provide medical support to the TPA operations team for claim audits and reconciliation.Required Qualifications & Skills:MBBS / BHMS / BAMS / equivalent medical qualification (MCI-registered preferred).1–3 years of experience in hospital TPA claim processing or medical audit.Sound knowledge of health insurance policies, cashless & reimbursement claim processes.Strong analytical and documentation skills.Proficiency in MS Office and hospital management software (HMS).Good communication and coordination abilities.
-
Claims Officer
20 hours ago
Elamakkara, Kochi, Kerala, India Regiis Insurance Brokers Private Limited Full time**Job Summary**: The Claims Officer will be responsible for managing end-to-end claims processing, ensuring accurate and timely settlement, maintaining claims-related MIS, and assisting with underwriting tasks. The role requires coordination with insurers, clients, and internal teams to facilitate smooth claim resolution while upholding compliance and...
-
Executive Insurance
5 days ago
Kochi, Kerala, India Lakeshore Hospital and Research Centre Full time**Key Responsibilities**: - Coordinate with patients, TPAs, and insurance companies for pre-authorizations, approvals, and claim settlements. - Verify insurance details and ensure accuracy of patient documentation. - Process and track cashless and reimbursement claims efficiently. - Ensure timely submission and follow-up of insurance claims. - Maintain...
-
Claim Submission Officer
1 week ago
Kochi, India Healthcare Careers Full timeAssess claim settlement within the designated authority limit. Attend to claim investigations. Attend to policyholders, claimants, and intermediaries inquiries. Communicate claims decisions clearly. Oversee claims daily operations. Provide quality service to all intermediaries and clients. Experience: Good Knowledge in XML **Job Types**: Full-time, Regular...
-
Medical Insurance Coordinator
1 week ago
Kochi, Kerala, India Logicorp Technologies Full timeThe Medical Insurance Coordinator is responsible for ensuring seamless coordination between patients, healthcare providers, and insurance companies to facilitate accurate billing, maximize insurance coverage, and minimize financial burdens for patients. This role requires strong attention to detail, excellent communication skills, and a deep understanding of...
-
Insurance Claim Support
2 weeks ago
Kochi, Kerala, India Advenxa Pvt.Ltd Full time**Hiring Insurance -Claims Support L2** Location: Infopark, Kakkand (Work from Office) Experience: Minimum 1.5 years in **Insurance back-office processes, preferably in Claims support** **Educational Requirements**: - Graduates or Postgraduates, preferably with a Commerce background. - Joining Date: Immediate (4th or 5th October 2024) **Basic...
-
Medical Biller
5 days ago
Kochi, Kerala, India 33 Holdings Global Full time**Job description** **Company Description** - 33 Holdings Global is a research and strategic consulting company based in Kochi. We specialize in helping in-house brands unlock growth through diversified business strategies and expansion plans. From purpose to product, brand to experience, customers to operations, we provide the insight, rigor, and expertise...
-
Medical Biller
5 days ago
Kochi, Kerala, India 33 Holdings Global Full time**Company Description** - 33 Holdings Global is a research and strategic consulting company based in Kochi. We specialize in helping in-house brands unlock growth through diversified business strategies and expansion plans. From purpose to product, brand to experience, customers to operations, we provide the insight, rigor, and expertise needed to uncover...
-
Resident Medical Officer
1 week ago
Kochi, India Sukino Healthcare Solutions Full timeCCF Clients' Admission Process - Active participation in the clients' admission process at the Continuum Care Facility, from a medical, holistic & continuum care point of view, understanding the needs of the client and the scope of services needed. - The admission process at Sukino Continuum Care Facility (CCF) star - The admission process at Sukino...
-
Insurance Executive
1 week ago
Kochi, Kerala, India RCMASSIST HEALTHCARE SOLUTIONS PRIVATE LIMITED Full time**JOB INTERACTIONS** **NATURE OF INTERACTION** - Insurance Coordination Cashless Desk Management at associated hospitals TPA/Insurance patient co-ordination and documentation /counselling Assemble and maintain patient records, review transcriptions and interact with Associated Hospitals to ensure all relevant patient information are recorded for...
-
Assistant Manager
2 weeks ago
Kochi, Mumbai, India Futurisk Insurance Broking Full time ₹ 30,00,000 - ₹ 55,00,000 per yearFuturisk insurance Broking is HiringRole : Assistant Manager / Deputy Manager Customer ExperienceLocations :KochiLocations : Mumbai ( Marol )CTC : 3L- 5.5L / annumIf interested , pls share your cv to .Key Responsibilities:Service Delivery & Client SupportManage end-to-end service delivery for assigned corporate clients as per agreed standards.Support Client...