Mh Am claims (thane ) Jobs – 9 Open Jobs Today

Team Member - Case Management
Aditya Birla Group —Maharashtra
- Microsoft Powerpoint
- Medicine
- Microsoft Excel
AM-Ops Claims (Thane)
Aditya Birla Group —Maharashtra
- Part-time
- Microsoft Excel
- APIs
- Time management
AM-Claims (Thane )
Aditya Birla Group —Maharashtra
- Part-time
- Microsoft Excel
- APIs
- Time management
AM-Claims (Thane)
Aditya Birla Group —Maharashtra
- Part-time
- Microsoft Excel
- APIs
- Time management
AM- Claims ( Thane)
Aditya Birla Group —Maharashtra
AM/DM- Health Management
Aditya Birla Group —Maharashtra
- Microsoft Excel
- Microsoft Office
- EMR systems
- Health insurance
Team Member – Social Media (THN)
Aditya Birla Group —Maharashtra
- Microsoft Powerpoint
- CRM software
- Microsoft Excel
Health Coach
Aditya Birla Group —Maharashtra
- EMR systems
- In-person
TM-FWA- Cochin
Aditya Birla Group —Maharashtra
- Part-time

More jobs to discover

Find similar jobs that you might be interested in.

AM-Ops Claims (Thane)
Aditya Birla Group —Maharashtra
Real time client Dashboard for client reviews. Debit note supervision for all the payments from TPA’s & OPD Partners Viz. Monthly MIS check - For TAT.
Team Member - Case Management
Aditya Birla Group —Maharashtra
It involves the timely coordination of quality healthcare services to address a client’s specific needs in a cost-effective manner to promote optimal outcomes…

I want to receive the latest job alerts for am claims (thane ) in mh

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

am claims (thane ) jobs near mh

Social Media Specialist jobs in Maharashtra

Facilities Manager jobs in Delhi

Case Manager jobs in Gurugram, Haryana

Case Manager jobs in Nehru Place, Delhi, Delhi

Case Manager jobs in Bengaluru, Karnataka

Restaurant Manager jobs in Tamil Nadu

Case Manager jobs in Noida, Uttar Pradesh

Quality Manager In Hospital, Nabh jobs in Pune, Maharashtra

Us It Recruitment Manager jobs in Hyderabad, Telangana

Social Media Specialist jobs in Mazgaon Road, Mumbai, Maharashtra

Assistant Professor, Social Work jobs in Guwahati, Assam

Corporate Social Responsibility jobs in Pune, Maharashtra

Social Media Specialist jobs in Park Street, Kolkata, West Bengal

Social Media Specialist jobs in Hyderabad, Telangana

Social Media Specialist jobs in Hari Nagar Ashram, Delhi, Delhi

Dainik Bhaskar Group, Hiring For Print Media jobs in Jaipur, Rajasthan

In Mental Health jobs in Mumbai, Maharashtra

Physical Education Teacher, Sports Coach jobs in Mumbai, Maharashtra

Health Coach jobs in Tamil Nadu

Health Coach jobs in Mumbai, Maharashtra

Team Member - Case Management

Aditya Birla Group -
Maharashtra

Apply Now

Job details

Qualifications

Microsoft Powerpoint
Medicine
Microsoft Excel
Medical coding
Data analysis skills
MBBS
Master's degree
Bachelor's degree
Healthcare management
CPT coding
BAMS
MBA
Communication skills

Full job description

Designation:

Location: India Maharashtra Thane - GCorp

Organization: Financial Services

Job Description:

PFB JD for Case Management TM (team member)

Job Position: AM / DM / Manager

Location: Thane Mumbai

Department: Ops Claims

Job Summary:

We are seeking detail-oriented individuals to join in our highly dynamic and fast growing case management team in claims operations.

It involves the timely coordination of quality healthcare services to address a client’s specific needs in a cost-effective manner to promote optimal outcomes for customers.

This role focuses on reviewing, analysing the claims, identifying and resolving the abuse, inflation in claims, adherence to policy terms.

The ideal candidate will ensure compliance with policies, prevent financial losses, and uphold the integrity of the claims process while collaborating with internal teams and external healthcare providers with customer centric approach.

Key Responsibilities:

1. Claim Review:

Review the claims for admissibility, noted irregularities, overbilling, or unnecessary procedures.
Conduct root-cause analyses of claims using claims data, treatment records, and provider contracts, standard treatment guidelines and protocols

2. Cost Management, Utilization Review:

Review plan of care medical necessity and admissibility with cost effectiveness and minimizing claim disputes

Monitor adherence to insurer-provider contracts, IRDAI guidelines, and internal policies.

Conduct audits of high-risk claims and hospital billing practices.

3. Communication and Collaboration for Resolution

Liaise with network hospitals, doctors and internal stake holders (claims, underwriting, FWA) / Third-Party Administrators (TPAs), to resolve disputes in real time for customer.
Identify non-compliance and get corrective action on identified non-compliant via direct communication for quick resolution.
Real time coordination with hospitals to clarify discrepancies and ensure adherence to approved treatment protocols for facilitating best customer experience during their claim.

4. Documentation, data analysis & Reporting

Maintain records of case progress, Identify trends
Prepare and maintain reports on findings, recommendations for process improvements.

5. Patients advocacy, continuous Learning and quality improvement:

Educate internal and external stake holders on ethical practices and billing abuse, policy / contract terms
Stay updated on healthcare regulations, coding standards (ICD, CPT), and emerging fraud tactics.

Education:
Bachelor’s degree in Medicine (MBBS/BAMS/BHMS), MBA in Healthcare Management, or related field.

Experience:
Minimum 2-3 yrs. experience preferably in Hospitals TPA department, Health Insurance, Claim processing, Claim investigation,

Knowledge Requirement:

Familiarity with cashless claim processes, TPAs, and insurer-provider contracts.
Understanding of health insurance policy terms, Clinical protocols, medical coding (ICD-10, CPT), IRDAI guidelines

Skills:

Strong clinical knowledge and analytical and problem-solving abilities.
Excellent communication for negotiations and stakeholder collaboration.
Proficiency and knowledge of MS Excel, PowerPoint and/or analytics tools
Knowledge of health insurance terms and IRDA guideline
Customer first approach and detail oriented

Key Competencies:

High ethical standards and attention to detail.
Ability to manage multiple cases in a fast-paced environment.
Critical thinking to assess complex claims and billing patterns.
Quick learner and Process oriented.

Work Environment

Work from Office, 5 working days in a week

Apply Now

Refine Your Search

am claims (thane ) jobs in mh

Team Member - Case Management

AM-Ops Claims (Thane)

AM-Claims (Thane )

AM-Claims (Thane)

AM- Claims ( Thane)

AM/DM- Health Management

Team Member – Social Media (THN)

Health Coach

TM-FWA- Cochin

More jobs to discover

I want to receive the latest job alerts for am claims (thane ) in mh

Explore jobs in more locations

Job Description:

Jobseeker tools

Employer Tools

Browse

Stay Connected