Greeting From Link-K Insurance TPA Pvt Ltd We are hiring Medical Officer for our Claims Team at our Kerala office. Job Role: Medical Officer Industry: TPA/Health Insurance Location: Trivandrum, Kerala Qualification: MBBS, BDS, BAMS, BHMS,.. Roles & Responsibilities of Cashless / Claims - Medical Officer / Doctor : Processing of health insurance claims submitted by policyholders, hospitals, or healthcare providers. Get fully trained and understand claims software, functionality and validations. Verify whether the claim falls within the coverage/ scope of the health insurance policy. Check medical details in the claim documents and determine admissibility of the claim. Examine medical records, diagnostic reports, treatment plans, and other relevant documents to verify the authenticity and medical necessity of the services claimed. Check for pre-existing conditions, policy exclusions, waiting periods, and any other relevant policy provisions. Coding of ailments /procedures as per the regulatory requirement of coding the ailments/diseases/ procedures Validate the accuracy billing information submitted in the claims to prevent fraudulent or inflated billing. Evaluate the medical necessity of the treatments or procedures claimed, considering standard medical guidelines and best practices. Raising appropriate queries to hospitals, doctors, other healthcare providers and members to gather additional information or clarify details related to the claims. Be vigilant in identifying potential fraudulent claims and report them to the appropriate authorities for further investigation. Make informed decisions regarding the approval, partial approval, or denial of insurance claims based on the medical assessment and policy terms and conditions. Maintain a high level of accuracy and quality in claims processing to ensure customer satisfaction and adherence to regulatory standards. Help and support to other team members in billing, quality check, CRM, CS and contact center to clarify customer queries satisfactorily. Stay up-to-date with relevant healthcare laws, regulations and industry standards to ensure compliance in claims processing. Give necessary inputs to team leads for enhancement in IT system and better processes. Regular interaction with Provider Network management team and claims investigation teams to give inputs about the billing practices of hospitals for better negotiations, any suspected fraudulent billing practices noticed to red flag providers and suggestion for better internal controls. Interested candidate can send your updated resume to [email protected] Job Types: Full-time, Permanent Pay: ₹30,000.00 - ₹35,000.00 per month Benefits: Provident Fund Schedule: Day shift Work Location: In person

Greeting From Link-K Insurance TPA Pvt Ltd We are hiring Medical Officer for our Claims Team at our Kerala office. Job Role: Medical Officer Industry: TPA/Health Insurance Location: Trivandrum, Kerala Qualification: MBBS, BDS, BAMS, BHMS,.. Roles & Responsibilities of Cashless / Claims - Medical Officer / Doctor : Processing of health insurance claims submitted by policyholders, hospitals, or healthcare providers. Get fully trained and understand claims software, functionality and validations. Verify whether the claim falls within the coverage/ scope of the health insurance policy. Check medical details in the claim documents and determine admissibility of the claim. Examine medical records, diagnostic reports, treatment plans, and other relevant documents to verify the authenticity and medical necessity of the services claimed. Check for pre-existing conditions, policy exclusions, waiting periods, and any other relevant policy provisions. Coding of ailments /procedures as per the regulatory requirement of coding the ailments/diseases/ procedures Validate the accuracy billing information submitted in the claims to prevent fraudulent or inflated billing. Evaluate the medical necessity of the treatments or procedures claimed, considering standard medical guidelines and best practices. Raising appropriate queries to hospitals, doctors, other healthcare providers and members to gather additional information or clarify details related to the claims. Be vigilant in identifying potential fraudulent claims and report them to the appropriate authorities for further investigation. Make informed decisions regarding the approval, partial approval, or denial of insurance claims based on the medical assessment and policy terms and conditions. Maintain a high level of accuracy and quality in claims processing to ensure customer satisfaction and adherence to regulatory standards. Help and support to other team members in billing, quality check, CRM, CS and contact center to clarify customer queries satisfactorily. Stay up-to-date with relevant healthcare laws, regulations and industry standards to ensure compliance in claims processing. Give necessary inputs to team leads for enhancement in IT system and better processes. Regular interaction with Provider Network management team and claims investigation teams to give inputs about the billing practices of hospitals for better negotiations, any suspected fraudulent billing practices noticed to red flag providers and suggestion for better internal controls. Interested candidate can send your updated resume to careers@linkktpa.com Job Types: Full-time, Permanent Pay: ₹30,000.00 - ₹35,000.00 per month Benefits: Provident Fund Schedule: Day shift Work Location: In person

Greeting From Link-K Insurance TPA Pvt Ltd We are hiring Senior Medical Officer for our Claims Team at our Chennai Corporate office. Job Role: Medical Officer Industry: TPA/Health Insurance Location: Anna Nagar, Chennai Experience: 3 Years+ Preferred Male Candidate Qualification: MBBS, BDS, BAMS, BHMS,.. Roles & Responsibilities: Processing of health insurance claims submitted by policyholders, hospitals, or healthcare providers. Get fully trained and understand claims software, functionality and validations. Verify whether the claim falls within the coverage/ scope of the health insurance policy. Check medical details in the claim documents and determine admissibility of the claim. Examine medical records, diagnostic reports, treatment plans, and other relevant documents to verify the authenticity and medical necessity of the services claimed. Check for pre-existing conditions, policy exclusions, waiting periods, and any other relevant policy provisions. Coding of ailments /procedures as per the regulatory requirement of coding the ailments/diseases/ procedures Validate the accuracy billing information submitted in the claims to prevent fraudulent or inflated billing. Evaluate the medical necessity of the treatments or procedures claimed, considering standard medical guidelines and best practices. Raising appropriate queries to hospitals, doctors, other healthcare providers and members to gather additional information or clarify details related to the claims. Be vigilant in identifying potential fraudulent claims and report them to the appropriate authorities for further investigation. Make informed decisions regarding the approval, partial approval, or denial of insurance claims based on the medical assessment and policy terms and conditions. Maintain a high level of accuracy and quality in claims processing to ensure customer satisfaction and adherence to regulatory standards. Help and support to other team members in billing, quality check, CRM, CS and contact center to clarify customer queries satisfactorily. Stay up-to-date with relevant healthcare laws, regulations and industry standards to ensure compliance in claims processing. Give necessary inputs to team leads for enhancement in IT system and better processes. Regular interaction with Provider Network management team and claims investigation teams to give inputs about the billing practices of hospitals for better negotiations, any suspected fraudulent billing practices noticed to red flag providers and suggestion for better internal controls. Important Note: Only candidates with an experience in TPA or Health Insurance are eligible. Interested candidates can send their updated resume to [email protected] . Job Types: Full-time, Permanent Pay: ₹30,000.00 - ₹35,000.00 per month Benefits: Provident Fund Schedule: Day shift Work Location: In person

We’re Growing – Join Our Team! Looking for passionate professionals ready to take their career to the next level. Position: Customer Retention & Insurance Liaison (CRM) Industry: Insurance/TPA Experience: 4 years+ CTC: 3.5LPA to 5LPA Location: Ameerpet, Hyderabad Roles & Responsibilities: Act as the primary point of contact between the insurance company, corporate client enrolment and claims teams Build and maintain strong relationships with insurance companies and their various offices. Coordinate for policies, data and endorsements. Tracking outstanding claims waiting for insurers approvals and claims waiting for endorsements. Follow up with insurers for logical closure of those claims. Taking up resolution of claims pending for payment requiring underwriting office interference. Coordinate with other teams for logical closure of claims associated with insurers approvals. Periodical visits to underwriting offices, track meeting outcome and report. Attend agent meets wherever retail business is allocated Attend periodical meetings called for by insurers to represent the company Understand the business portfolio of various insurers, seek relevant reports from MIS and have all information handy to respond to insurer queries Build strong relationship with brokers and corporate clients. Foster long-term relationships with clients and brokers to maximize retention. Provide exceptional customer service and act as a point of contact for any client inquiries or issues. Collaborate with internal such as operations, claims, and IT to ensure seamless service delivery and exceed client expectations. Team management of corporate relationship/client servicing executives in the region. Important Note: Health Insurance / TPA Profile only eligible. Looking Candidate for Immediate Joiner. Interested candidate can send your updated resume to careers@linkktpa.com. Job Types: Full-time, Permanent Pay: ₹30,000.00 - ₹40,000.00 per month Benefits: Provident Fund Schedule: Day shift Ability to commute/relocate: Hyderabad, Telangana: Reliably commute or planning to relocate before starting work (Required) Experience: TPA / Health Insurance: 2 years (Required) Willingness to travel: 100% (Required) Work Location: In person