Job Title: Manager Mediclaim (Hospital)

Location: Pune

Department: Mediclaim / Claims Processing

Job Purpose:

The Manager Mediclaim (Hospital) will oversee the management and processing of Mediclaim (health insurance) claims within the hospital setting. This role ensures timely, accurate, and compliant submission and settlement of claims with insurance companies, while providing excellent customer service to patients and insurers.

Key Responsibilities:

1. Claims Management:
   
• Review and process mediclaim applications and associated medical documents.
• Ensure accuracy and completeness of all mediclaim submissions.
• Coordinate with insurance companies to resolve any discrepancies in claims.
• Monitor the status of outstanding claims and follow up for timely settlement.
• Provide detailed information to patients regarding their claim status and process.
2. Insurance Liaison:
   
• Establish and maintain relationships with health insurance companies, third-party administrators (TPAs), and other stakeholders.
• Communicate with insurance providers regarding pre-authorization requirements and policy details.
• Ensure compliance with insurers guidelines, policies, and claim processing procedures.
3. Documentation & Compliance:
   
• Ensure all mediclaim records and documentation are maintained in accordance with hospital policies and regulatory standards.
• Review and verify patient details, diagnosis, and treatment plans for accuracy and consistency with insurance policies.
• Handle any disputes or issues related to claims and take necessary steps to resolve them in a timely manner.
4. Team Management & Training:
   
• Lead, mentor, and train the mediclaim team in proper claims processing procedures and customer service techniques.
• Organize and conduct regular meetings to review performance, address concerns, and introduce process improvements.
5. Reporting & Analysis:
   
• Generate and review reports related to the mediclaim process (e.g., claim settlement status, approval/rejection rates).
• Analyze trends and work to improve operational efficiency in claims processing.
• Provide periodic updates to senior management on claim processing performance, outstanding claims, and key issues.
6. Customer Service:
   
• Provide exceptional customer service to patients and their families regarding any queries or concerns about their insurance claims.
• Address and resolve any patient or insurer complaints in a timely and professional manner.

Key Skills and Qualifications:

• Education: Bachelors degree in Healthcare Administration, Business Administration, or a related field. A Masters degree or relevant certifications (e.g., in insurance or healthcare management) is a plus.
• Experience:
• 5+ years of experience in medical claims processing, insurance coordination, or a related field, with at least 3 year in a managerial role.
• In-depth understanding of hospital billing, Mediclaim policies, insurance protocols, and claims processing systems.
• Skills:
• Strong communication and interpersonal skills.
• Attention to detail and accuracy.
• Ability to work under pressure and handle multiple tasks simultaneously.
• Knowledge of relevant regulations and healthcare compliance standards.
• Proficient in using claim management software and Microsoft Office Suite.

Work Environment:

• Hospital setting with interaction between medical staff, insurance companies, patients, and the claims department.
• The position may require flexibility in work hours based on hospital and claim processing requirements.

Interested candidates can walk in with their updates resume or email at hr@noblehrc.com.

Thanks

HR Team