Executive - Mediclaim

2 weeks ago

Indore Madhya Pradesh Central India Shalby Limited Full time

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JOB DESCRIPTION 

BASIC INFORMATION

Position Title & Designation

Executive

JD Code

SHB/XXX/DEPT/NNN

Job Family

Business Support

Department

Mediclaim

ROLE DETAILS

To be filled up as per the requirement of the Division / unit / function / territory

Grade

A2

Reporting To

Mediclaim Manager

Division

Unit

Unit 

Indore

LOCATION DETAILS

Please mention  the correct office location of the Role selected above and fill in the other geographic details

Base Location (City) 

Indore

Country

India

Job-Holder Specifications

QUALIFICATION

Basic Qualification / Education / Vocational Training

Graduation in any discipline

Advanced

Qualification / Certification / Specialist Training

NA

EXPERIENCE

Minimum Experience

2 years

Specific / Relevant Experience

2 years

COMPETENCIES

Functional Skills and Capabilities

Behavioural

  • Courteous and professional approach
  • Responsible in nature
  • Polite in speech 
  • Problem solving ability
  • Tolerant

Functional

  • Knowledge about mediclaim procedure for TPA
  • Well equipped with computers
  • Thorough with company knowledge and packages
  • Documentation of data

Objective

To carry out the administrative and billing procedure by providing accurate estimates, checking the outstanding and smooth discharge process for TPA clients in the Mediclaim department.

Key Responsibilities

1

TPA Procedures

  • Receiving discharge file from mediclaim 
  • Preparation of checklist as per requirement
  • Handling and preparation of TPA files 
  • Receiving approval as per patient for outstanding for TPA
  • Making online approvals for approval of estimates and entering reference number, ID number, name
  • Reviewing of payments online from time to time
  • Making settlement entries after receiving from accounts department
  • Identifying TPA portals and mails for making and tallying settlements.
  • Making entry in portal, tally and careworks
  • Analysing the payment received into legitimate and illegitimate
  • Provide reasoning and communication for illegitimate payments
  • Updating the payments on the CEO tracer
  • Preparation of outstanding report patient wise on a monthly basis
  • After the discharge, follow up with companies for outstanding payments
  • Maintaining database about international patient for outstanding payment of assigned units.
  • Resolving queries related to file submission and payments
  • Coordinating within the department as per requirement
  • Visiting the TPA agencies whenever required for early recovery of the dues.
  • Follow up with departments for missing documents
  • Completion of patient files as per requirements of Insurance companies.
  • For CGHS and ECHS cases, claim processing to be done within 1 week or as stipulated.
  • Visiting the coordinators of CGHS and ECHS whenever required to resolve queries.

Employee Name

Employee Signature

Received on (Date)

05-Jan-2021

Version No: 001/

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