Manager - Health Claims
3 hours ago
Role Summary The role is responsible for managing and expanding the provider (hospital) network through empanelment, tariff negotiations, compliance, and process audits. The Manager ensures smooth coordination between hospitals, internal teams, and clients to improve turnaround time (TAT), control claim leakages, and strengthen the overall provider network. The position also supports IRDA initiatives such as Cashless Everywhere. Key Responsibilities Provider Network Management Empanel/de-panel hospitals and expand the network, PAN India. Meet hospital owners/admins and ensure agreement renewals & documentation. Tariff Negotiation & Cost Control Negotiate tariffs and discounts. Reduce claim costs and control claim leakages. Audit & Fraud Control Audit hospital bills and processes. Identify overcharging and prevent fraud. Team Leadership Handle a PAN India team, track performance, and meet targets. Interdepartmental Coordination Work with Claims, Fraud Control, Medical, and Customer Service for smooth operations. Regulatory (IRDA) Compliance Support “Cashless Everywhere” and ensure hospitals follow regulatory guidelines. Skills & Competencies Strong experience in provider network expansion, empanelment & de-panelment. Hands-on experience in tariff negotiation, discount savings, and hospital visits. High integrity; strong understanding of fraud indicators and ethical practices. Comfortable onboarding 8–10 hospitals per day when required. Knowledge of legal documents, contracts, and compliance. Team handling ability with a PAN India distributed team. Strong communication, relationship building & field coordination skills. Willingness to travel extensively PAN India.
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Claims Adjudicator I
7 days ago
Pune, Maharashtra, India Evolent Health Full timeYour Future Evolves Here Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins....
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Subject Matter Expert(Health Claims)
5 days ago
Pune, Maharashtra, India CG-VAK Software & Exports Ltd. Full time ₹ 12,00,000 - ₹ 24,00,000 per yearJob SummaryWe are seeking a highly skilled and experienced Subject Matter Expert (Medico) with 7-10 years offocused experience in the health insurance industry, particularly in claims processing. Understandingthe key KPIs that drive claims processing is critical. The candidate will play a crucial role in bridging thegap between business needs and IT...
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Subject Matter Expert(Health Claims)
6 days ago
Pune, Maharashtra, India CGvak Software Exports Full time ₹ 12,00,000 - ₹ 24,00,000 per yearJob Summary:We are seeking a highly skilled and experienced Subject Matter Expert (Medico) with 7-10 years offocused experience in the health insurance industry, particularly in claims processing. Understandingthe key KPIs that drive claims processing is critical. The candidate will play a crucial role in bridging thegap between business needs and IT...
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Pune, Maharashtra, India Sayas Cooperative Society Ltd. Full time**Job Description: Marketing & Claim Handling** **Executive (Health Model)** **Position**: Marketing & After-Service Claim Handling Health Model Executive**Location**: Pune**Type**: Full-Time**Experience Level**: Freshers can apply**Preferred Qualification**: Bachelor's Degree in Medicine (BAMS, BHMS, or equivalent) **Key Responsibilities**: - Marketing...
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pune, India MetaMorphoSys Technologies Full timeBusiness Analyst – Health Insurance Platform (Hong Kong) About Us MetaMorphoSys is a next-generation InsurTech product company transforming life and health insurance across Asia. We offer a unified platform across five core value streams: Claims, Underwriting, Provider Management, Benefit Configuration, and FWA. Our platform is live across multiple...
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Pune, India MetaMorphoSys Technologies Full timeBusiness Analyst – Health Insurance Platform (Hong Kong) About Us MetaMorphoSys is a next-generation InsurTech product company transforming life and health insurance across Asia. We offer a unified platform across five core value streams: Claims, Underwriting, Provider Management, Benefit Configuration, and FWA. Our platform is live across multiple...
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Pune, India MetaMorphoSys Technologies Full timeBusiness Analyst – Health Insurance Platform (Hong Kong) About Us MetaMorphoSys is a next-generation InsurTech product company transforming life and health insurance across Asia. We offer a unified platform across five core value streams: Claims, Underwriting, Provider Management, Benefit Configuration, and FWA. Our platform is live across multiple...
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Pune, India MetaMorphoSys Technologies Full timeBusiness Analyst – Health Insurance Platform (Hong Kong) About Us MetaMorphoSys is a next-generation InsurTech product company transforming life and health insurance across Asia. We offer a unified platform across five core value streams: Claims, Underwriting, Provider Management, Benefit Configuration, and FWA. Our platform is live across multiple...
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Pune, India MetaMorphoSys Technologies Full timeBusiness Analyst – Health Insurance Platform (Hong Kong)About UsMetaMorphoSys is a next-generation InsurTech product company transforming life and health insurance across Asia. We offer a unified platform across five core value streams: Claims, Underwriting, Provider Management, Benefit Configuration, and FWA. Our platform is live across multiple markets...
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Pune, India MetaMorphoSys Technologies Full timeBusiness Analyst – Health Insurance Platform (Hong Kong)About UsMetaMorphoSys is a next-generation InsurTech product company transforming life and health insurance across Asia. We offer a unified platform across five core value streams: Claims, Underwriting, Provider Management, Benefit Configuration, and FWA. Our platform is live across multiple markets...
