Cashless Processing-Adjudicator ,Team Leads, Head.

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.