Experience

• 

  C-zon hospital

  Sept 2021 - now

  Senior executive tpa & corporates i ab-pmjay coordinator

  1. Claim Processing: Overseeing the end-to-end process of claims management, including receiving, verifying, processing, and adjudicating claims efficiently and accurately.2. AB-PMJAY Coordinator: Verifying the eligibility of AB-PMJAY beneficiaries, generating Ayushman Cards, and overseeing the entire process from preauthorization to discharge, claim settlement and Coordination with SHA team. 3. Provider Network Management: Establishing and maintaining a network of healthcare providers, negotiating contracts, establishing seamless collaboration with TPA’s and insurance companies for hospital empanelment. 4. Billing: Proficiently handling billing of IPD patients. 5. Policy Adherence: Ensuring that claims processing follows the terms and conditions outlined in insurance policies and regulatory guidelines.6. Customer Service: Addressing queries and concerns from policyholders, providers, and other stakeholders, and providing clear and helpful information about claims procedures.7. Compliance and Regulation: Staying updated with industry regulations, compliance requirements, and best practices, and ensuring that the TPA operates within legal boundaries.8. Coordination with Insurers: Collaborating with insurance companies to facilitate seamless claim processing, providing necessary documentation, and resolving any disputes or discrepancies.9. Data Management: Maintaining accurate and up-to-date records of claims, policyholders, providers, and other relevant data, and generating reports for analysis and reporting.10. Technology Utilization: Leveraging software and technology platforms for efficient claims processing, data management, and reporting.11. Cost Containment: Implementing strategies to control costs associated with claims processing, such as identifying fraudulent or excessive claims. Show less