Senior/Chief Manage - Health Claims

POSITION OVERVIEW

This position works for the hospital empanelment to increase the network of the hospitals. 

ROLE AND RESPONSIBILITIES

• Should have experience in empanelment process creating a good network of hospitals to provide cashless for RGICL customers.
• Quality check and necessary documents, including legal, financial, and operational details. These documents are reviewed to ensure compliance with regulatory requirements and industry standards.
• Should be comfortable to travel to multiple hospitals
• Have knowledge in payment disputes & grievances i.e. disputes over claim amounts, eligibility, or documentation, Denials due to incomplete paperwork which leads to NEFT Rejections.
• Cashless Support/Anywhere cashless Providing network confirmation of hospital, due diligence of documentation required for anywhere cashless to provide seamless cashless experience to RGICL policy holders.
• Tariff knowledge and should have hospital experience
• Provider audit includes operational / clinical/ financial /compliance – Recovery & potential savings of subsequent FY.
• Identification of common usage procedure / analyse billing codes - identify for renegotiation / better discount (Virtual meeting with providers)
• Identify fraud trends & create deterrence in market.

EDUCATION & EXPERIENCE REQUIREMENTS

• BHMS/BAMS with good experience with region as a scope 
• Exposure in the same role with previous organisation 

 PREFERRED SKILLS

• Customer First Attitude and Adaptive to change and pick-up any new task/role
• Should have good communication Skills (English, Hindi, Regional language will be added advantage)
• Should have good Convincing & Listening Skills
• Ability to learn new things and self-motivated
• Team Management Skills
• Negotiation Skills