Manager Insurance Adjudication @ Karthika Consulting

Medical Insurance Adjudication Department at We Assist has an important role of managing the relationship with Insurance Companies, Hospital Relations, Billing Related Queries, Client Relationship Management to ensure that the We Assist continues to be a competitive service provider in the Insure Tech, Reimbursement Claim Settlement and the related industry. With ambitious growth plans in mind, We Assist is looking to offer cutting edge solutions to both patients and the partner hospitals by leveraging technology and with unique product offerings.
As a Manager Insurance Adjudication, the managerial level candidate is required to manage the team of Executives and Assistant Managers in the Adjudication Department that supports the TPA/Insurance relationships and necessary paperwork related to Cashless & Reimbursement insurance claims for the smooth functioning of the day-to-today operations.

Job Duties & Responsibilities
Play as an intermediate role Between the Insurance co. and Hospital and WeAssist Team.
Adjudicating cashless and Reimbursement claims with claim documents provided by help desk executive.
Evaluating of claims and posting the remarks in what's app group and updating in CRM.

Should be able to do claim tabulation to bifurcate payable and non-payable items as per the terms and conditions laid out in the insurance policy.
Monitoring billing as per the Tariff.
Managing claims escalations form hospitals.
Responsible to handling query's raised by insurance company / TPAs
Provide technical assistance and to conduct training sessions for new processors on various health insurance policies.
Evaluate complete claim documents before submission.
Coordinate with Internal team to understand patient enquires.
Helping team to understand the Non-medical Items.
Periodically educating claim assistance department about the changes in the policy, rules & regulations and application deduction on settlement.
To create awareness about reimbursement claims. (Pre, Post & Hospitalization) and communicating the important updates to the Claims Assistance and Finance Department
Be available at the office for supporting onsite staff on all six days in a week b/w 9.30am to 7.00pm
Efficiently and effectively handle grievance / issue raised by hospital staff & patients, escalate issue to the team leader, Regional Manager Claims Assistance, Manager Operations and Business Head as necessary.
Follow-up on the updates to be given to the clients / onsite team of Claims Assistance Department
To manage the assigned the team of Insurance Adjudication Executives and Assistant Manager Operations

Qualifications & Skills.
Graduation in B-Pharma / D-Pharma /MBBS/BAMS/ or any medical or paramedical qualifications like physiotherapy or nursing
4 -6 years of relevant experience
Should have good analytical skills
Excellent interpersonal & communication skills

Experience.
4 - 6 years of experience in TPA or Insurance claims or similar field
Additional Skills.
Strong verbal skills Fluency in English & Kannada.
Strong problem-solving skills and enthusiasm for new tasks and challenges
Relationship building skills.
Ability to multitask and prioritize, with a strong work ethic and attention to detail
Ability to operate with a high level of confidentiality and professionalism
Willingness to accept a high degree of uncertainty, jump in and help wherever needed, get hands dirty, and wear multiple hats on a fast-moving team.
Should be able to manage the task assigned, while managing the tasks of the team/ team members that are assigned
Should have an ability to manage and maintain smooth relationship with cross functional department such as Finance, Claims Assistance, Back-Office and Marketing Team

About Us
We Assist is a disruptor in the field of InsureTech, Reimbursement Claims, Partner for many renowned Corporate Hospital Chains
We Assist offers one of its kind services that is designed to assist Health Insurance customers for a hassle-free Reimbursement Claim Experience. In the last 5 years we have solved thousands of reimbursement cases and boast about many happy customers. While the hospitals and family members of patients are focusing on the well-being of the patients, we take care of the cumbersome logistics and the laborious claim process on client's behalf.
Our 3 decades of experience and the legacy in the insurance industry via our parent company Karthika Insurance makes it easier to interact with the key stake holders and to get the job done on behalf of Partner Hospitals and Patients. We are based out of Bangalore, Karnataka and soon spreading our wings across India and are looking to grow faster.
Candidates can mail their resume to [Confidential Information], [Confidential Information] or message/ what's App +91 8431238***, + 91 9019928***, +91 7996110***