Iit Bombay Maharashtra Tpa Jobs – 79 Open Jobs Today

PHI - Assistant Manager- Claims Management
Prudential plc —Mumbai, Maharashtra
- Full-time
- Analysis skills
- Communication skills
- Negotiation
Front Office (OPD/IPD/TPA/ Billing) - KoparKhairane, Navi Mumbai
RG Stone Urology & Laparoscopy Hospital —Navi Mumbai, Maharashtra
Success Manager (Hospital)
SAIJYOT MULTI SPECIALITY HOSITAL —Navi Mumbai, Maharashtra
- ₹25,000 - ₹30,000 a month
- Full-time
- Microsoft Excel
- Customer service
- Microsoft Office
- Flexible schedule
Quick apply
6d
Junior Officer / Officer / Senior Officer – Customer Care (Admission)
Kokilaben Dhirubhai Ambani Hospital —Mumbai, Maharashtra
- Bachelor's degree
OPD/IPD Billing
S.L Raheja Hospital —Mumbai, Maharashtra
- Communication skills
Senior Billing Executive
LMH healthcare services Private Limited —Borivali, Mumbai, Maharashtra
- ₹25,000 - ₹35,000 a month
- Full-time
- Bachelor's degree
- In-person
- Medical terminology
Quick apply
12d
Head – Finance, TPA & Billing
Guru Nanak Hospital —Mumbai, Maharashtra
- Email
- Finance
- Master's degree
- MBA
RMOs/Ward Officers
S.L Raheja Hospital —Mumbai, Maharashtra
- Rotational shift
- Medicine
- Bachelor's degree
Operations Manager
Paramount Health Services —Andheri, Mumbai, Maharashtra
- Travel
- Diploma
Medical Transcription - KoparKhairane, Navi Mumbai
RG Stone Urology & Laparoscopy Hospital —Navi Mumbai, Maharashtra
- Bachelor's degree
- Diploma
Frontline customer service
Fortis Healthcare —Navi Mumbai, Maharashtra
- ₹10,474.77 - ₹34,162.32 a month
- Full-time
- In-person
- Health insurance
- Paid time off
Quick apply
Customer Service Representative
Gurukrupa Placement —Goregaon, Mumbai, Maharashtra
- ₹15,000 - ₹20,000 a month
- Full-time
- CRM software
- Microsoft Excel
- Bachelor's degree
Quick apply
1d
Resident Medical Officer (Night)
Acharya Shri Nanesh Hospital —Navi Mumbai, Maharashtra
- From ₹40,000 a month
- Full-time
- Patient monitoring
- Bachelor's degree
- Patient care
Quick apply
4h
Admin Assistant
Sparsh Childrens Hospital —Parel, Mumbai, Maharashtra
- ₹18,000 - ₹22,000 a month
- Full-time
- Microsoft Excel
- Software troubleshooting
- Computer literacy
- Health insurance
Quick apply
Receptionist/Front Office (Hospital Background)
Uphil HR Services —Mumbai District, Maharashtra
- ₹25,000 - ₹30,000 a month
- Full-time
- Customer service
- 12th Pass
- Bachelor's degree
- Health insurance
Quick apply
14d
Medical Billing Executive
Siddhachal Hospital LLP —Mumbai, Maharashtra
- From ₹20,000 a month
- Weekend availability
- Microsoft Excel
- Customer service
- Microsoft Office
Quick apply
PHI - Assistant Manager- Operations
Prudential plc —Mumbai, Maharashtra
- Full-time
- Microsoft Excel
- SQL
- Analysis skills
Data Entry Executive
Ericson Insurance TPA Pvt Ltd —Chembur, Mumbai, Maharashtra
- ₹10,000 - ₹15,000 a month
- Full-time
- Microsoft Excel
- Databases
- Data entry
Quick apply
14d
Call Centre Executive
Paramount Health Services —Andheri, Mumbai, Maharashtra
- Bachelor's degree
Hospital Accountant
Medilife Hospital —Ulwe, Navi Mumbai, Maharashtra
- ₹10,000 - ₹20,000 a month
- Full-time
- Microsoft Excel
- Accounting
- In-person
Quick apply
12d

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PHI - Assistant Manager- Claims Management

Prudential plc -
Mumbai, Maharashtra

Apply Now

Job details

Full-time

Qualifications

Assistant manager experience
Analysis skills
CPT coding
BAMS
Communication skills
Negotiation

Full job description

Prudential’s purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured, for our people, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and we support our people’s career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.

Prudential (UK) in partnership with HCL group plans to set-up a standalone Indian health insurance company to address the growing healthcare needs of the Indian consumer.

This joint venture will combine Prudential's global expertise in insurance and financial services with HCL Group’s experience in technology and healthcare solutions.

Prudential, with its longstanding presence in India, already operates two leading businesses in life insurance and asset management with the ICICI Group. Prudential was also the proud sponsor of the 1983 Cricket World Cup, India’s first World Cup Victory!

Prudential Health India is a Zero to One team undertaking a no-legacy, greenfield health insurance deployment in India, building journeys that truly empathize with the customer and offer a differentiated experience.

To partner with us in this mission, we are looking for a talented Assistant Manager – Claims Management to join our Experience team in Mumbai.

Assistant Manager – TPA Claims Management

As an Assistant Manager Claims, your typical week might include the following:

Guiding TPA processing team by providing medical opinion for Health Insurance Claims
Ensure claims of valid settlements are made according to the company practice and procedures.
Processing and approving medical claims pertaining to Indemnity, Benefit for both Group and Retail, with sharp FWA and Loss minimization approaches.
Thorough on the compliance and regulatory requirements and implementation in the claims process.
Case management of potential cases to Network team, maintaining data of referred/saving achieved/impact against cashless outgo.
Automation and rule driven decision making with timely update of benefit in TAT / TMS / Transaction
Create and reviewing claim simplification guidelines to Improve TAT, Minimize transaction.
Medical decisioning and guidance to the team
Audit of TPA processed claims and also Inhouse processed claims.
Regulatory compliances – Claim processing guideline as per compliance and timely implementation of any New Circular.
Train TPA teams – Timely Training of TPA for new benefit, process change, Understanding and claim Philosophy as per PHI standard.
Benefit claims – Well versed with processing of Benefit claims, Creating SOP, Pay-out framework to Nominee/Legal heir.
Collaborate with FWA Manager to provide inputs from agencies for efficient Fraud restriction and necessary checks and balances in system.
Re-UW opinion for non-disclosure cases – Training to Team for indicated cases for Re-UW referral, tracking and corrective action basis UW decision.
Extend support to the sales/distribution – Separate prioritization que for green channel, Specific Agent, Broker.
Set up and create robust governance to manage TPA process with great efficiency.
Proficient with medical terms & systems (including ICD/CPT/PCS codes).

You could be the right candidate if you…

Are a doctor by training (/BAMS/BHMS/BDS)
Have 03-05 years’ experience of health Insurance claim processing management with at least 1-2 years’ experience as team leader managing and holding responsibility daily claim flow.
Understands the TPA ecosystem and has experience of managing TPA model (Preferred)
Have startup experience or setting up a team from scratch (Preferred but not mandatory)
Should be a decisive & creative individual.
Should be able to make quick decisions and have good judgment and analytical skills
Have an excellent verbal and written communication skills and strong negotiation skills.
Always open to embracing change and be able to manage it

This could be the gig for you if you…

Are passionate about consumer behaviour and culture; enjoy spending time with customers to understand what they really want. Have an attentive ear listen to new ideas.
Like to work in a culture where everyone can see what others are doing
Take help from others when stuck and encourage others when there are setbacks
Take full responsibility for your own output while thinking wing to wing across the organization; to solve for the customer
Have strong clinical knowledge and clinical decision-making skills
Have built best in class processes from a scratch.
Are passionate about leveraging digital tools to transform customer experience What can make you extra special.

What can make you extra special

It’s a great if you have already read books like Blue Ocean strategy & Zero to One. Before you saw them mentioned here.
You have real stories to tell about how your team, and you challenged convention and took the path less travelled.
We are keen to listen to your story; doesn’t matter if you tell these stories with a sigh or with excitement. We respect both versions. Truly.

Location: Mumbai

Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation irrespective of sex, race, age, ethnic origin, educational, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability or part-time / fixed-term work, or any other status protected by applicable law. We encourage the same standards from our recruitment and third-party suppliers taking into account the context of grade, job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements.

Apply Now

Refine Your Search

tpa jobs in iit bombay maharashtra

PHI - Assistant Manager- Claims Management

Front Office (OPD/IPD/TPA/ Billing) - KoparKhairane, Navi Mumbai

Success Manager (Hospital)

Junior Officer / Officer / Senior Officer – Customer Care (Admission)

OPD/IPD Billing

Senior Billing Executive

Head – Finance, TPA & Billing

RMOs/Ward Officers

Operations Manager

Medical Transcription - KoparKhairane, Navi Mumbai

Frontline customer service

Customer Service Representative

Resident Medical Officer (Night)

Admin Assistant

Receptionist/Front Office (Hospital Background)

Medical Billing Executive

PHI - Assistant Manager- Operations

Data Entry Executive

Call Centre Executive

Hospital Accountant

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