Chief Medical Officer - Begumpet Hyderabad

Good Health TPA Hiring for #CMO profile.

Company Overview :

Good Health TPA Services is a leading Third Party Administrator in India licensed by IRDA, covering over 4,50,000 lives. The company provides excellent Third Party Administration services in health insurance to individual and corporate clients across various sectors. Formed in 2003 and merged with ICare Health Management Services in 2012, Good Health TPA is headquartered in Hyderabad and operates from multiple offices across the country.

Role Description

This is a full-time on-site role for a Chief Medical Officer at Good Health TPA in Hyderabad. The Chief Medical Officer will be responsible for overseeing health claims management, operations and compliance with strategic planning within the organization.

Roles & Responsibilities:

• Medical protocol in line with risk exposure
• Process automation.
• Create various dashboard for effective monitoring of the processes.
• Contracting and liaising with Health care providers across India for better tariff and discount
• Claims management for effective processing with close TATs
• Leveraging on historical claims pay-out and trend to analyze for future negotiations.
• Regular fraud risk assessments and assessments of risks to share inputs to Investigation teams.
• Attending insurance review meetings on claims processing and cost containment.
• Contracting and liaising with Health care providers across India for better tariff and discount Leveraging on historical claims pay-out and trend to analyze for future negotiations
• Managing the overall process of Claims settlement and adherence of policy terms and condition Responsible for audit review for quality and error implementation of actionable.
• Establish internal control and compliance processes in line with standard internal operating procedures.
• Resolve customers complaints, operations related matters and claims issues across all functional lines.

Education : MBBS with MCI Qualified

Location : Begumpet Hyderabad

Year of experience : 10 + Years

Compensation : 20L to 30L

Interested candidates can share their cv to Sandeep.Digambar@isbsindia.in

Note : We are looking for candidates only from TPA & Insurance exposure candidates not from Hospital background.