Director of Insurance Claim Management

3 weeks ago

Mumbai, Maharashtra, India Talent Destination Full time

The Director of Insurance Claim Management position at Talent Destination involves overseeing hospital coordination, insurance claim processing, and TPA operations. A successful candidate will have a strong background in healthcare insurance operations, fraud prevention, risk management, and regulatory compliance.

Hospital Coordination:

  • Manage relationships with hospital billing departments to ensure seamless service coordination.
  • Oversee admission, discharge, and cost verification processes, ensuring adherence to CarePal's pricing agreements.
  • Lead efforts to streamline billing accuracy, end-to-end claim processing, optimize reconciliation processes, and enhance the patient experience.

Billing Verification & Reconciliation:

  • Conduct cost verification and reconciliation with hospital billing & Finance teams to prevent discrepancies and ensure adherence to agreed rates.
  • Develop structured reconciliation processes to accurately track and validate patient costs.
  • Identify opportunities for cost-saving and process improvement in billing workflows.

Patient Journey & Health Insurance Coordination:

  • Oversee the full patient journey from admission through discharge, ensuring compliance with healthcare insurance guidelines.
  • Coordinate with TPA and hospital teams for seamless admission, discharge, and insurance claim processes.
  • Ensure all insurance-related processes are efficient, accurate, and meet regulatory standards.

Patient Background Verification:

  • Manage patient background verification processes, ensuring accurate information validation.
  • Implement standardized procedures for patient verification, proactively identifying and resolving discrepancies.
  • Maintain high standards of trust and safety by ensuring complete and accurate patient onboarding till claim settlement.

TPA Operations & Insurance Claim Management:

  • Lead TPA operations, focusing on claims processing, insurance documentation, and patient eligibility verification.
  • Collaborate with TPA providers and insurance companies to ensure streamlined workflows and compliance.
  • Enhance TPA operations by optimizing processes, reducing processing times, and improving patient satisfaction.

Fraud Prevention & Risk Management:

  • Oversee insurance claim processes, implementing fraud detection and prevention strategies.
  • Regularly monitor and audit for fraud risks, addressing any detected anomalies.
  • Maintain high standards of trust by managing systems that prevent fraudulent activities in patient billing and insurance claims.

Policy Development & Compliance:

  • Develop policies to uphold trust and safety in patient operations, aligning with healthcare and insurance standards.
  • Regularly update policies to comply with regulatory changes and industry trends.
  • Ensure strict adherence to data privacy laws, healthcare regulations, and insurance guidelines across all operations.

Risk Analysis & Escalation Management:

  • Conduct risk assessments to identify potential issues, especially in hospital coordination, TPA processes, and patient verification.
  • Lead escalation protocols to resolve trust and safety concerns promptly in collaboration with hospital and insurance partners.
  • Regularly review processes to minimize risk and maintain high standards of operational integrity.

Data Analysis & Reporting:

  • Utilize data analytics to track operational trends, identify areas for improvement, and monitor patient satisfaction.
  • Prepare regular reports on trust and safety metrics, incident outcomes, and fraud prevention results for executive leadership.
  • Use data insights to refine processes, enhance efficiency, and guide strategic decision-making.

Team Leadership & Development:

  • Lead and mentor the Trust & Safety team, fostering a culture of accountability, integrity, and excellence.
  • Ensure team members are well-trained in trust and safety protocols, billing verification, and insurance claims processes.
  • Set clear objectives, conduct performance reviews, and support professional growth within the Bachelor's degree in healthcare management, business administration, or a related field.

    Requirements:

    • Bachelor's degree in healthcare management, business administration, or a related field.
    • MBA or equivalent advanced degree preferred.
    • 10+ years of experience in Health Insurance, claim processing, with a focus on TPA management, hospital coordination, and billing.
    • Demonstrated success in managing healthcare insurance claims, billing verification, and trust and safety protocols.
    • Strong expertise in healthcare insurance operations, fraud prevention, risk management, and regulatory compliance.
    • Proven leadership skills, with experience managing cross-functional teams and optimizing complex operational workflows.
    • Excellent communication, negotiation, and stakeholder management abilities.

    Estimated salary: $120,000 - $180,000 per year.

    Talent Destination offers a dynamic work environment, competitive compensation package, and opportunities for professional growth and development.

  • Insurance Claims Professional

    1 week ago

    Mumbai, Maharashtra, India Anand Rathi Insurance Brokers Ltd Full time

    Claims Manager Job DescriptionWe are seeking an experienced and skilled Claims Manager to join our team at Anand Rathi Insurance Brokers Ltd. As a key member of our claims function, you will play a crucial role in ensuring the efficient and accurate processing of insurance claims.Key Responsibilities:Claims Processing and Documentation: Accurately review and...

  • Insurance Claims Specialist

    1 week ago

    Mumbai, Maharashtra, India Anand Rathi Insurance Brokers Ltd Full time

    **Anand Rathi Insurance Brokers Ltd: Unlock Your Potential as a Claims Manager**We are seeking an experienced and skilled Claims Manager to join our team. The successful candidate will be responsible for effectively managing the claims process, ensuring timely resolution of claims, and maintaining client satisfaction.**Key Responsibilities:**Accurately...

  • Insurance Claims Processor

    3 days ago

    Mumbai, Maharashtra, India Anand Rathi Insurance Brokers Ltd Full time

    Job SummaryWe are seeking a skilled Insurance Claims Processor to join our team at Anand Rathi Insurance Brokers Ltd. As a key member of our claims function, you will play a vital role in ensuring the efficient and accurate processing of insurance claims.Key ResponsibilitiesReview and process claims in adherence to established protocols and guidelinesEnsure...

  • Insurance Claims Resolution Specialist

    1 week ago

    Mumbai, Maharashtra, India Anand Rathi Insurance Brokers Ltd Full time

    Company Overview:Anand Rathi Insurance Brokers Ltd is a leading insurance broking company dedicated to providing exceptional claims processing services.Compensation and Benefits:We offer a competitive salary of $80,000 per annum, along with benefits such as health insurance, retirement plans, and paid time off.Job Description:The Claims Role involves...

  • Insurance Claims Specialist

    3 weeks ago

    Mumbai, Maharashtra, India Anand Rathi Insurance Brokers Ltd Full time

    About Anand Rathi Insurance Brokers LtdWe are a leading insurance broking company dedicated to providing exceptional claims services to our clients.

  • Claims Management Professional

    2 days ago

    Mumbai, Maharashtra, India Anand Rathi Insurance Brokers Ltd Full time

    At Anand Rathi Insurance Brokers Ltd, we are seeking a highly skilled Claims Manager to join our team. This is an excellent opportunity for someone looking to excel in the field of insurance claims management.Job SummaryWe are looking for a Claims Manager who will be responsible for managing the entire claims process, from initial claim submission to...

  • Claims Specialist

    3 weeks ago

    Mumbai, Maharashtra, India Anand Rathi Insurance Brokers Ltd Full time

    Insurance Claims Manager at Anand Rathi Insurance Brokers LtdJob Summary:We are seeking an experienced and skilled Claims Manager to join our team at Anand Rathi Insurance Brokers Ltd. As a Claims Manager, you will be responsible for managing the claims process from initial receipt to final settlement, ensuring timely resolution of claims and maintaining...

  • Claims Specialist

    6 days ago

    Mumbai, Maharashtra, India Anand Rathi Insurance Brokers Ltd Full time

    About Anand Rathi Insurance Brokers LtdAnand Rathi Insurance Brokers Ltd is a leading insurance brokerage firm that offers comprehensive insurance solutions to individuals and businesses.Job Title: Claims SpecialistWe are seeking an experienced Claims Specialist to join our team. The successful candidate will be responsible for managing the claims process,...

  • Insurance Claim Processing Manager

    3 weeks ago

    Mumbai, Maharashtra, India Impact Guru Technology Ventures Pvt Ltd Full time

    About the Company:CarePal Group is transforming healthcare financing in India by providing cutting-edge solutions that make critical and elective treatments more accessible and affordable.Job Summary:The AVP of Operations - Trust & Safety will drive CarePal Group's trust and safety strategy, overseeing hospital coordination, insurance claim processing, and...

  • Claims Operations Specialist

    3 weeks ago

    Mumbai, Maharashtra, India Anand Rathi Insurance Brokers Ltd Full time

    The Claims Operations Specialist plays a pivotal role in our insurance broking company, facilitating efficient and accurate claims processing. This position aims to ensure timely resolution of claims, maintain client satisfaction, and uphold the organization's credibility by adhering to ethical and legal standards.Key Responsibilities:Claims Processing and...

  • Insurance Claims Management Expert

    4 weeks ago

    Mumbai, Maharashtra, India Impact Guru Technology Ventures Pvt Ltd Full time

    Job Description:The ideal candidate for this role is a seasoned healthcare operations expert with a strong background in trust and safety management. They will oversee the development and implementation of strategies to ensure the highest level of trust and safety across our operations, working closely with our hospital and insurance partners. This involves...

  • Insurance Claims Expert

    3 weeks ago

    Mumbai, Maharashtra, India Impact Guru Technology Ventures Pvt Ltd Full time

    About the Opportunity:This is a unique opportunity to join a leading healthcare technology company as an Insurance Claims Expert. The successful candidate will be responsible for driving our trust and safety strategy, overseeing hospital coordination, insurance claim processing, and TPA operations.Main Responsibilities:Drive trust and safety standards across...

  • Healthcare Insurance Director

    3 weeks ago

    Mumbai, Maharashtra, India Talent Destination Full time

    About the JobWe are looking for an experienced Healthcare Insurance Director to join our team at Talent Destination. In this role, you will be responsible for developing and implementing our trust and safety strategy, with a focus on claim processing, hospital coordination, and billing verification.You will work closely with our TPA providers and insurance...

  • TPA Claims Manager

    18 hours ago

    Mumbai, Maharashtra, India Talent Corner HR Services Full time

    We are seeking a highly organized and experienced professional to manage the claims process from start to finish, ensuring timely and accurate processing of claims for our clients.This role requires strong communication skills, attention to detail, and a thorough understanding of insurance claims procedures.Key Responsibilities:Act as the main point of...

  • TPA Claims Manager

    1 day ago

    Mumbai, Maharashtra, India Talent Corner HR Services Full time

    We are seeking a highly organized and experienced TPA Executive to join our insurance company's claims and back office team. As a key member of our team, you will be responsible for managing the claims process from start to finish, ensuring timely and accurate processing of claims for our clients.Key Responsibilities:• Act as the primary point of contact...

  • Medical Professional with Claims Adjudication Expertise

    2 weeks ago

    Mumbai, Maharashtra, India Volo Health Insurance TPA Pvt Ltd Full time

    Location: Mumbai/Bangalore, IndiaJob Type: Full-timeJob Summary: We are seeking a skilled Medical Officer to join our team at Volo Health Insurance TPA Pvt Ltd. As a Medical Officer, you will be responsible for evaluating medical admissibility of claims and providing expert opinions.Key Responsibilities:Evaluate medical admissibility of claims by verifying...

  • Insurance Claims Processor

    4 weeks ago

    Mumbai, Maharashtra, India WTW Full time

    We are seeking a skilled Insurance Claims Processor to join our team at WTW Global Delivery and Solutions India Private Limited. This is a hybrid role that offers the perfect blend of work and life.About the JobAs an Insurance Claims Processor, you will be responsible for delivering accurate and timely claims processing services to our clients. Your primary...

  • Insurance Claims Specialist

    2 weeks ago

    Mumbai, Maharashtra, India WTW Full time

    Company OverviewWTW Global Delivery and Solutions India Private Limited is a leading provider of insurance claims services.

  • Risk Management Specialist

    4 weeks ago

    Mumbai, Maharashtra, India MMC Full time

    Job OverviewWe are looking for a seasoned professional to join our Casualty Advisory team at Marsh McLennan. As a Director of Casualty Advisory, you will be responsible for leading a team of analysts and managers to perform in-depth data analysis, identifying trends, emerging risks, and cost drivers within US casualty claims.Responsibilities:To develop and...

  • Credit Insurance Director Lead

    7 days ago

    Mumbai, Maharashtra, India Client of SolveCube Full time

    As a Credit Insurance Director Lead at the Client of SolveCube, you will oversee and optimize the company's insurance operations. The ideal candidate will possess negotiation skills, advanced knowledge of insurance products, and proven leadership abilities to manage a team.The estimated annual salary for this role is between $120,000 and $180,000, depending...