Medical Officer – TPA Claim Process
2 days 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.
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Claims Specialist
1 week ago
bangalore, India Plum Full timeAbout Job:-Claims Management Specialist is responsible for processing and managing cashless insurance claims efficiently and accurately, ensuring timely closure to policyholders and seamless coordination with insurance providers.The job purpose of a Claims Management Specialist is to process and manage cashless claims for employees. This includes verifying...
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Claims specialist
4 weeks ago
Bangalore, India Plum Full timeAbout Job:- Claims Management Specialist is responsible for processing and managing cashless insurance claims efficiently and accurately, ensuring timely closure to policyholders and seamless coordination with insurance providers. The job purpose of a Claims Management Specialist is to process and manage cashless claims for employees. This includes...
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Claims Clerk
2 days ago
bangalore, India Scry AI Full timePosition: Claims Clerk – Subject Matter Expert (SME) Location: India (Remote) Employment Type: Full-Time Schedule: Monday to Friday, Day Shift Experience: 2+ years in insurance/TPA claims operations with SME-level proficiency Company Description Scry AI is a research-led enterprise AI company that builds intelligent platforms to drive efficiency, insight,...
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Claims Clerk
4 days ago
bangalore, India Scry AI Full timePosition: Claims Clerk – Subject Matter Expert (SME)Location: India (Remote)Employment Type: Full-TimeSchedule: Monday to Friday, Day ShiftExperience: 2+ years in insurance/TPA claims operations with SME-level proficiencyCompany DescriptionScry AI is a research-led enterprise AI company that builds intelligent platforms to drive efficiency, insight, and...
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Claims Associate
5 days ago
Bangalore City, Bengaluru, Karnataka, India Nexcen IT Services Pvt Ltd Full time**Freshers with strong written and verbal communications can apply** **Job Profile Summary** To provide administrative and operational support to the claims team and carry out other assigned office tasks in alignment with the requirements of the client program. **Primary Purpose**: To assist in the creation and maintenance of Auto Liability (AL), General...
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Senior Assistant TPA Insurance
6 days ago
Bangalore, FHML-Nagarbhavi, Building No. , Survey No. , India Fortis Healthcare Limited Full time ₹ 8,00,000 - ₹ 24,00,000 per yearSenior Assistant TPA InsuranceThe Senior Assistant TPA Insurance role is based in Bangalore. The position involves working in the field of Banking / Insurance / Financial Services. The candidate will be responsible for handling third party administrator (TPA) insurance claims and providing support to the insurance team
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Health Claim Specialist
3 days ago
bangalore, India iAssist Innovations Labs Full timeJob Description:We are seeking a detail- oriented and experienced Health Claims Specialist to join our team. The ideal candidate will be responsible for accurately processing and adjudicating medical claims in accordance with company policies, industry regulation, and contractual agreements. The Health Claims Specialist will play a crucial role in ensuring...
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Claims Specialist
2 weeks ago
Bangalore, India Plum Full timeAbout Job:- Claims Management Specialist is responsible for processing and managing cashless insurance claims efficiently and accurately, ensuring timely closure to policyholders and seamless coordination with insurance providers. The job purpose of a Claims Management Specialist is to process and manage cashless claims for employees. This includes...
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3 Days Left: Senior Executive Non Motor Claims
3 weeks ago
Bangalore, Karnataka, India Bajaj Allianz Full timeTeam Management Participate in recruitment process to identify the right talent within the function Guide and direct the team in efficiently achieving their targets Establish individual performance expectations and regularly review individual performance of the team Identify and create development opportunities for team members to enhance functional...
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Claims Representative
2 weeks ago
Bangalore, Karnataka, India The Cigna Group Full timeAbout UsAt CIGNA Healthcare we are guided by a common purpose to help make financial lives better through the power of every connection Responsible Growth is how we run our company and how we deliver for our clients teammates communities and shareholders every day One of the keys to driving Responsible Growth is being a great place to work for our...
