Assistant Manager - Claims Friday, 5 August 2016 No Comment

Job Summary

Locations:

Mumbai, Mumbai City

Nationality:

India

Experience:

3 – 8 years

Keywords / Skills :

Insurance, Claims, Mediclaim, TPA, GMC, GPA, Insurance Broking, Claims Management

Education:

Any graduate

Function:

Banking, Insurance & Financial Services

Role:

Claims Management

Industry:

Insurance

Summary:

Urgent opening for claims profile with reputed insurance broking firm. Candidate must posses excellent communication skills and excel skills.

Posted On:

4th Aug 2016

-Track claims through daily MIS received from TPA thru a customized Medimaange MIS (as per Cleint Specific agreed SLA)

-Ensure closuers of cases crossing TAT by coordinating with TPA

-Maintain records for escalated cases

-DNF cases to be reviewed and push for endt through the KAM/RM/CH/AH

-Ensure communication updates thru TPA represnetatives ( employee emails, system generated updates etc.)

-Get the IDNF claims reviewed within 24 hours of receiving the endt

-Ensuring Manual processing of the claims till the endt is received and get the queries raised if deficient

-Reviewing of IR claim by checking the validity of IR raised, if the claim can be settled by deduct & pay and for the documents procurement, from the networking hospital, push the TPA to facilitate in completing the documentation

-For payments (if crosses the TAT) & concurrence cases, sending mails to the RM/ CH

-Track of the investigation (15 days) & Hold cases (15 days)

-Checking the deduction details in settled claims

-Coordinate – Denial claim confirmation from CPH

-Track the cashless claims maintained through 1/2/3hrly dashboard

-Manage VIP cases / escalated Cases

-Check – Cashless recd but not registered in 1 hour

-Check – Cashless Registered but not processed within 3hour

-For the cashless where emp/dep are not covered, co-ordinate with RM/KAM for temporary cashless

-Maintain records for escalated cases

-To monitor monthly networking hospital list to the HR

-Ensure Revert to Employee E-mails within 12 working hours by coordinating with TPA, if required PMO & CPH

-Weekly report to PMO – Active MIS & Claim/Cashless processing TAT, ENDO/TEMP Cashless report & escalated cases

-Exceptional claim management report

InsuranceClaimsMediclaimTPAGMCGPAInsurance BrokingClaims Management

Medimanage Insurance Broking Private Limited

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Assistant Manager - Claims

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