TPA Executive - - Fortis Healthcare Ltd - 3
- Fortis Escorts
- 3 - 7 years
- Delhi, NCR
- 3 years ago
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Job Description
Roles and Responsibilities
- 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
Desired Candidate Profile
BDS/BHMA / Post Graduate + 3-7 year of relevant experience.
Eligible candidates can share their resume at um********a@fo*************e.com
Job Classification
Industry: Medical Services / HospitalFunctional Area: Healthcare & Life Sciences,
Role Category: Health Informatics
Role: Health Informatics
Employement Type: Full time
Education
Under Graduation: Any GraduatePost Graduation: Any Postgraduate
Contact Details:
Company: Fortis HealthcareAddress: Okhla Road, New Delhi, NEW DELHI, Delhi, India
Location(s): Delhi, NCR
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Keyskills: TPA
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Fortis Escorts
With a legacy of over 32 years, Fortis Escorts Heart Institute, New Delhi has established itself as a pioneer in the field of cardiac care, and is recognised for its path-breaking work and services to numerous heart patients. Armed with clinical expertise and cutting-edge technology, Fortis Escor...
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