Medical Officer – TPA Claim Process

3 weeks ago

Vijayawada, India Nucleon Health Full time

Job Title: Medical Officer – TPA Claim Process Department: TPA / Health Insurance Desk Location: Vadodara Reporting To: TPA Manager / Operations Head Job 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.

  • Medical Billing Executive

    3 days ago

    Gollapudi, Vijayawada, Andhra Pradesh, India Novacare Healthcare Solutions Pvt Ltd Full time

    Novacare Healthcare Solutions Pvt Ltd is a leading pharmaceutical distribution company dedicated to providing high-quality products and services to the healthcare industry. Job Summary: We are seeking a Medical Billing Executive to manage and process medical billing transactions, ensuring accuracy, compliance, and timely reimbursement. Key...

  • Factory Medical Officer in Reputed Cement Industry at Vijayawada

    1 week ago

    Vijayawada, Andhra Pradesh, India Convate Consultancy Services Full time ₹ 3,60,000 - ₹ 7,20,000 per year

    Dear Candidate,We have a Job Opening for Factory medical officer in Reputed Cement Industry at VijayawadaRequirement Details:Location: VijayawadaDesignation: Factory medical officerExperience: 3 to 5 YearsQualification: MBBS (Mandatory), AFIH (Mandatory)Expected Notice Period: Immediate to 30 daysIf you are interested, kindly share your updated CV to with...

  • Provider Management/Healthcare Purchasing

    1 week ago

    Vijayawada, Andhra Pradesh, India ICICI Lombard Full time ₹ 15,00,000 - ₹ 25,00,000 per year

    Management Profile: Provider Management/Healthcare PurchasingRoles & Responsibilities:Tariff Negotiations and cost managementConducting surprise audits and checks of the claims and case to case negotiationsManage workload of both field and office effectivelyExperience in dealing with providers (Hospitals/Diagnostics & OPD Clinics)Understanding of Health...

  • Csa

    2 weeks ago

    Vijayawada, India Firstsource Healthcare Full time

    **Job Summary**:A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications. The claims examiner should also route the claim to different department or provider / member for any missing information that required for claims adjudication. The claims...

  • Back Office Executive

    1 week ago

    Vijayawada, India Cyrix Healthcare Pvt Ltd Full time

    1) **Data Entry** - keralite preferable - Diploma / B.Tech in Biomedical in Biomedical medical - Above 3 years experience - MS- Excel knowledge - Malayalam, English, Hindi ,Telugu 2) **Admin** - keralite preferable - MBA Handling Admin - Above 5 years Experience - MS Office Knowledge - Malayalam, English, Hindi,Telugu 3) **Store Manager** - keralite...

  • Sales And Marketing Executive

    2 days ago

    Hyderabad, Vijayawada, Visakhapatnam, India Arcom Medical Devices Full time ₹ 5,00,000 - ₹ 15,00,000 per year

    We are seeking a dynamic and result-oriented Sales and Marketing Executive with experience in the Pharma or Medical Equipment industry. The ideal candidate will be responsible for driving sales growth, building strong client relationships, and implementing effective marketing strategies to expand the companys presence in the assigned region.Key...

  • Sales Officer

    6 days ago

    Emerging Enterprise Banking>South >Andhra Pradesh>AP and TG>Vijayawada>Vijayawada>Secunderabad Vf (Regional Office)-Secbd>>Vijayawada, India Equitas Small Finance Ltd Full time ₹ 4,00,000 - ₹ 8,00,000 per year

    Sales Officer - Strategic Key Responsibilities: Manage Receivables for the allotted set of customer Process Compliance Adhere to the laid down processes for repayment and relationship management with customer. Repayment Efficiency reduces the OD in the branch. Ensure payments are collected in time Continues Follow-up on Collection with the customer Customer...

  • Process Associate

    6 days ago

    Vijayawada, Andhra Pradesh, India Indinest Innovates Llp Full time ₹ 4,00,000 - ₹ 12,00,000 per year

    Collaborate with US client relationships via phone callsManage B2B sales pipeline through lead generation and communicationClose deals with convincing power and US voice processing expertise. Meet revenue targets consistentlyOffice cab/shuttleHealth insuranceLife insuranceAccidental insuranceSales incentivesAnnual bonusPerformance bonusJoining bonusProvident...

  • Branch Relationship Officer

    6 days ago

    Emerging Enterprise Banking>South>Andhra Pradesh>AP and TG>Vijayawada>Vijayawada>Secunderabad Vf (Regional Office)-Secbd>>Vijayawada, India Equitas Small Finance Ltd Full time ₹ 96,000 - ₹ 1,80,000 per year

    Branch Relationship Officer - UCV Key Responsibilities: Manage Receivables for the allotted set of customer Process Compliance Adhere to the laid down processes for repayment and relationship management with customer. Repayment Efficiency reduces the OD in the branch. Ensure payments are collected in time Continues Follow-up on Collection with the customer...

  • Sales Engineer-Medical Devices

    14 hours ago

    Bengaluru, Hyderabad, Vijayawada, India Ohyes Events Manpower Solutions Full time ₹ 8,00,000 - ₹ 12,00,000 per year

    Urgent Hiring Biomedical SalesLocation: Bangalore/Hyderabad/VijayawadaCompany: [Confidential]Position: Sales Executive Medical DevicesQualification (Mandatory): B.E./B.Tech in Biomedical Engineering B.Pharma candidates also eligibleAbout the JobSkillsMedical Devices and Equipment Sales ExperienceMedical Equipment KnowledgeSales & Business DevelopmentCustomer...