TPA Executive at Fortis C-Doc Hospital Ltd
- Fortis Healthcare
- 2 - 4 years
- Delhi, NCR
- 4 years ago
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Job Description
Roles and Responsibilities
Job description
- Ensuring smooth flow of customer centric operations and responsible for identifying areas for Improving and enhancing customer service initiatives through implementation of feedback received from them; successfully handle escalated issues
- Ensuring timely completion of all internal deliverables and maintaining MIS, reports, etc for management information purpose.
- Handling investigation and fraud detection in health and personal accident claims.
- Corporate /Provider network relation in Group Health/Retail Policies.
- Clients visit and grievance management in employee benefits policies
- Responsible for arranging health camps and health check-up for all valuable clients through wellness partners
- Responsible for maintaining strong relationship with network hospitals/wellness providers
- Liaison with network hospitals for smooth flow of pre-authorization request for all corporate and retail health policies
- Liaison with in-house TPAs for effective cashless and reimbursement claim process
- Liaison with external TPAs for timely processing of cashless and reimbursement claims
- Involved in TPAs claims audit and maintaining Service Level Adherence with them
- Monthly claims review meeting with clients & TPAs.
- Handling settlement TATS in health and personal accident claims
- Monitoring of retrieval claims, and quality control
- Monitoring TPAs function to ensure quality & accuracy in cashless & reimbursement claim settlement
- Involved in health claims analysis and extracting useful information including abnormal trends
- Involved in health loss presentation and analysis for renewal purpose
- Query handling in Health & Personal accident claim process and documentation
- Assistance to underwriting team on group health renewals
- Involved in health awareness sessions at clients location to enhance effective use of employee benefits policies.
- Strictly maintaining Service Level Adherence and complaint management with the teams end with good and timely coordination
Handling all audits internal or client requested
Required Candidate profile
Any Graduate can apply , having relevant experience in TPA/Billing department of minimum 2 years.
Eligible candidates can share their resume at fi********i@fo*************e.com
Job Classification
Industry: Medical Services / HospitalFunctional Area: Other, Role Category: OtherRole: OtherEmployement Type: Full timeEducation
Under Graduation: Any GraduatePost Graduation: Any PostgraduateContact Details:
Company: Fortis HealthcareAddress: Fortis C-Doc Hospital , B-16 , opp. Devika Tower , Chirag Enclave , New Delhi.Location(s): Delhi, NCR
Keyskills: TPA
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Fortis Healthcare Limited is a leading integrated healthcare delivery service provider in India. The healthcare verticals of the company primarily comprise hospitals, diagnostics and day care specialty facilities. Currently, the company operates its healthcare delivery services in India, Dubai, Maur...
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