HOD-Health Friend (HF)
Angel & Genie - Pune, Maharashtra
Job Description: ESSENTIAL DUTIES: Monitoring: 1. HF activities at Various hospital counters and Head Office(Billing) 2. Authentication process from HO with the help of Medical processors (Doctors) 3. Maintaining the team & helping in decision making for approval & denial 4. Responsible for maintaining TAT (Turnaround time) of 10-15 minutes for Cashless approvals. 5. Authentication process monitoring through software. 6. Bill finalization at the time of discharge 7. Discharge tracking to reduce Indus payable amount 8. Billing invoice - Final signatory for HF payments (Monitoring billing procedure & if needed auditing to check the authenticity) 9. Coordinating with Finance dept. 10. Getting daily centre report in specific format 11. Interviews of doctors & executives related of HF Empanelment of Hospitals: 1. Maintaining the team of empanelment doctors 2. Survey of the specific area hospitals as demanded by management 3. Selection of Hospitals by management & availability as required for Preventive health Packages & Health friend Cashless facilities 4. Negotiation on costing for Packages 5. Negotiation on discounts for Cashless facility ( Both premium & Standard ) 6. Study & comparison of SOCs 7. Managing Drafting of Agreements for both Preventive Health Packages and Health Friend 8. Hospital & Indus coordination during announcements Analysis: 1. IRDA report maintaining (Data Management)for both Premium & Standard patients 2. Maintaining training record format 3. Maintaining Service provider Analysis format 4. Maintaining complaint answer format 5. Maintaining Daily RAL report Grievance Readdressal forum (Health friend) 1. Maintaining Grievance readdressal forum through 2. Resolving of grievances at the time of Visits by investigating doctors 3. Resolving the Costumer care services telephonically 4. Getting the grievances on courtesy calls after discharges which can add to best service in next admissions 5. Resolving the walk in grievances (Grievances in form of written complaints, by mails or by fax or by letters at TAT of 8 days) 6. Dealing with hospitals if the grievance is from hospital side & replying back in the same form as it had come 7. Maintaining the daily reports from all grievance solving employees 8. Representation & Analysis of team during weekly meetings Management responsibilities- 1. Presentation of Claim Analysis report on monthly basis to the management. 2. Help management to take decision on Policy underwriting depending on Average claim Value 3. To ensure the maintenance of accurate and up-to-date information concerning the department on the management information system. 4. To analyze and evaluate, with the department, performance data provided and take appropriate action in response. Others: 1. Working of the legal and police system as it pertains to insurance claims and adjusting is required. 2. Maintaining the team involved in Investigations (Cashless Visits) in & out of Pune. 3. Scheduling training of the new employees & updating of old employees through Indus HO trained doctors. 4. Manage Updation of the testimonials on site on regular basis. NON-ESSENTIAL DUTIES: The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.

Desired Candidate Profile Experience: 8 years plus (Clinical - 3 years plus and TPA in Claims department - 5 years) Education qualifications: MBBS/ BHMS/ BAMS. Travelling 10-15 days in a month mandatory.

Experience Required : 8 to 10

Education Required : (UG - MBBS) AND (PG - Any PG Course)

SpanJobs.com - 22 months ago - save job - block
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