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4 Family Health Plan Jobs

Cashless Processing-Adjudicator ,Team Leads, Head.

13-15 years

Hyderabad / Secunderabad

1 vacancy

Cashless Processing-Adjudicator ,Team Leads, Head.

Family Health Plan

posted 26d ago

Job Role Insights

Flexible timing

Job Description


Cashless Lead Job Description

We aim to onboard Medical Professional with minimum relevant experience of 14 + years of in Health Insurance, Networking & Provider Management, Reimbursement and Cashless claim & Wellness activity and Health Care segment.


Role & responsibilities

Job Description:

  • Proven skills in rendering quality services while adhering to the SLAs & TAT; extensive experience in Cashless Adjudication and Operations.
  • Proficient in managing functions like cashless volumes, investigation & settlement, fraud control as per companys policies & IRDAI guidelines with skills in preparing MIS reports to apprise top management of insurance operations
  • Assist Management & Technical Teams in process automations, migrations & standardisation in the healthcare domain
  • Effective Leader with competencies in directing & motivating teams for accomplishment of organizational goals; accurate & precise in Cashless Medical Management KRA with command over professional communication
  • Preparing Weekly & Monthly Business Review Decks, goal sheets monthly, publishing Weekly, MTD Quality, Productivity, Deficit & People Engagement Reports, arranging Video Conferencing and managing day to job functions as a Cashless Team people manager
  • Address grievances and allegations arising out of Investigation
  • Assign cases for investigation to Vendors and follow up and upload the reports in the system after Quality check.
  • Processing cashless claims within TAT as per terms and condition pertaining to retail and corporate clients
  • Negotiation on Hospital bills for open cases and overcharging
  • Investigating the cases from investigating team were found suspicious
  • Taking approval of insurance companies for special cases on new procedure and Technique
  • Handling Cashless grievances from CRM team PAN India for cases where in Network Hospital are not issuing cashless for any undue reason
  • Ongoing cashless Negotiation from Hospital in cases of overcharging, non-adherence to tariff or open billing cases
  • Handling tripartite and bipartite project. Coordinating with branches for pendency pertaining to bipartite & tripartite
  • Refer cases to PMT Provider Management team with emphasis on getting EPD(Early Payment Discount) from Hospital where payment output is high
  • Collaborating with PMT to make Hospital arrange pending cashless files to avoid delay in settlement of claims of hospital to avoid closure of claims.
  • Share cases to PMT to negotiate for cashless with Network hospital in cases of overcharging and open billing


Profile is open for Location: FHPL Head Office Hyderabad.


Preferred candidate profile


Candidate must have a medical degree BHMS, BUMS, BAMS, MBBS, MD.





Employment Type: Full Time, Permanent

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What people at Family Health Plan are saying

What Family Health Plan employees are saying about work life

based on 494 employees
55%
46%
59%
99%
Flexible timing
Monday to Friday
No travel
Day Shift
View more insights

Family Health Plan Benefits

Health Insurance
Work From Home
Cafeteria
Team Outings
Job Training
Soft Skill Training +6 more
View more benefits

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