406 Tpa Jobs

Healthcare Insurance Decoding - 3 roles Location: Koramangala, Bangalore Hospital: Superhealth Hospitals Pvt. Ltd. Salary: Up to 50,000/month (Based on experience) Are you experienced in decoding health insurance policies and working with TPAs Join our dynamic Revenue Cycle team and help us ensure transparency and clarity in patient coverage. *Key Responsibilities:* Decode and interpret insurance policy benefits and terms Support billing and pre-auth teams with accurate policy data Liaise with TPAs and insurers for real-time information Maintain digital records and ensure compliance *Eligibility:* 24 years of hospital/TPA experience Proficient in reading policy documents and benefit charts Strong in communication and detail-oriented CONTACT HR PRIYA AT 9739398219 CANDIDATE SHOULD HAVE EXPERIENCE AS A TPA AND HAD WORKED IN HOSPITAL MANDATORY.

You could be the right candidate if you Have 5-6 years of experience in Travel Insurance operations and claims management with at least 2-3 years experience in lead/ equivalent role. Expert knowledge of Travel Insurance product features, process, regulatory and compliance requirements and implementation and management of comprehensive Travel insurance operations & claims management process. Aware of International Travel Insurance Medical Claims, terms & systems Understand the International Travel Insurance TPA ecosystem and have experience of managing TPA model Have startup experience or setting up a team from scratch (Preferred but not mandatory) Can make informed decisions, swiftly and are adept at creative problem solving; have good judgment and analytical skills Have excellent verbal and written communication skills and strong negotiation skills. Thrive in environments that celebrate co-creation and collaboration. Have high resilience - can manage yourself, your teams and your peers when faced with ambiguity or failure

You could be the right candidate if you Have 5-6 years of experience in Travel Insurance operations and claims management with at least 2-3 years experience in lead/ equivalent role. Expert knowledge of Travel Insurance product features, process, regulatory and compliance requirements and implementation and management of comprehensive Travel insurance operations & claims management process. Aware of International Travel Insurance Medical Claims, terms & systems Understand the International Travel Insurance TPA ecosystem and have experience of managing TPA model Have startup experience or setting up a team from scratch (Preferred but not mandatory) Can make informed decisions, swiftly and are adept at creative problem solving; have good judgment and analytical skills Have excellent verbal and written communication skills and strong negotiation skills. Thrive in environments that celebrate co-creation and collaboration. Have high resilience - can manage yourself, your teams and your peers when faced with ambiguity or failure

You could be the right candidate if you Have 5-6 years of experience in Travel Insurance operations and claims management with at least 2-3 years experience in lead/ equivalent role. Expert knowledge of Travel Insurance product features, process, regulatory and compliance requirements and implementation and management of comprehensive Travel insurance operations & claims management process. Aware of International Travel Insurance Medical Claims, terms & systems Understand the International Travel Insurance TPA ecosystem and have experience of managing TPA model Have startup experience or setting up a team from scratch (Preferred but not mandatory) Can make informed decisions, swiftly and are adept at creative problem solving; have good judgment and analytical skills Have excellent verbal and written communication skills and strong negotiation skills. Thrive in environments that celebrate co-creation and collaboration. Have high resilience - can manage yourself, your teams and your peers when faced with ambiguity or failure

Job description Walk-in Drive For Clinical Doctors at Cotiviti, Mohali Walkin Date :4th & 5th August 2025 Walkin Timing: 9:00AM TO 1:00 PM Interview Address: IT C-7, KMG Tower, 3rd Floor, Sector-67, SAS Nagar, Mohali, Punjab, 160062. Eligibility Criteria: Education: BHMS, BAMS, BPT, BUMS, MPT, MBBS Candidates with prior US Healthcare or Clinical exp will be preferred. (Freshers/Candidates with 1-3 Years of exp) Good team player with strong interpersonal skills and high integrity. Should be ready to work in rotational shifts including night shifts. Should be ready to work from office. Job Location: Mohali, Punjab

Urgent requirement for BHMS,BAMS -Nagpur Freshers/candidate with clinical or TPA experience. Interested candidates can call on 9371762436 or share their updated resumes to career@mdindia.com Job Description: Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Need to Do field Visit Required Candidate profile: BHMS,BAMS graduate. both male and female can apply Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also apply. Work from office. Need to travel in Nagpur for filed investigation

Job Title: Healthcare Insurance Decoding Executive Location: Koramangala, Bangalore Openings: 3 Salary: Up to 50,000/month (Based on experience) Industry: Healthcare / Hospitals Functional Area: Revenue Cycle / Insurance Processing Employment Type: Full-Time Job Description: We are hiring experienced professionals to join our Revenue Cycle team. If you have expertise in decoding health insurance policies and working with TPAs, this role is for you. Key Responsibilities: Decode and interpret health insurance policies and benefit terms Provide accurate policy insights to billing and pre-authorization teams Coordinate with TPAs and insurance providers for timely updates Maintain digital records and ensure process compliance Eligibility Criteria: 2 to 4 years of experience in hospitals or Third-Party Administrators (TPAs) Proficiency in reading insurance policy documents and benefit charts Strong communication skills and attention to detail Location Advantage: Centrally located in Koramangala with easy access to public transport.

Mega Walk-in Drive for Clinical Doctors on 02nd Aug 2025 (Saturday) @ Hyderabad . Eligibility: Education BHMS, BAMS, BUMS, BPT, BDS ( Physicians Only ) Candidates with prior US Healthcare or Clinical experience will be preferred. Good Communication Skills. Candidates with corporate experience will be preferred. Good team player with strong interpersonal skills & high integrity. Ready to work from office. Should be flexible to work in rotational shifts. Interested and eligible candidates can walk-in directly to below mentioned venue on time. Venue: Cotiviti India Pvt Ltd 10th Floor, Galaxy, Plot No.1, Sy.No.83/1, HYD Knowledge City, Raidurgam, Serilingampally Mandal, Hyderabad, Ranga Reddy, Telangana - 500081. Landmark : Opposite to IKEA Walk-in Date : 02nd Aug 2025 (Saturday) Walk-in Timings : 10Am - 1Pm (Only) Regards, Talent Acquisition Team

Roles and Responsibilities Candidate has to do TPA Empanelment. Candidate will handle entire billing part and documentation. TPA/Cashless /ECHS /CGHS /ESIC billing & documentation. Liaison with Govt. Health Departments. Liaison with Insurance Companies. Tie ups with Corporate Houses. Must be aware of norms of insurance sector. Desired Candidate Profile Good communication. Must have good command over MS Office. Candidate must have experienced in Third party/ Empanelment Corporate tie-ups. Must have experienced of Hospital. Must have Experienced TPA/Cashless/ECHS/CGHS processors. Perks and Benefits Performance based Incentives

You could be the right candidate if you Have 5-6 years of experience in Travel Insurance operations and claims management with at least 2-3 years experience in lead/ equivalent role. Expert knowledge of Travel Insurance product features, process, regulatory and compliance requirements and implementation and management of comprehensive Travel insurance operations & claims management process. Aware of International Travel Insurance Medical Claims, terms & systems Understand the International Travel Insurance TPA ecosystem and have experience of managing TPA model Have startup experience or setting up a team from scratch (Preferred but not mandatory) Can make informed decisions, swiftly and are adept at creative problem solving; have good judgment and analytical skills Have excellent verbal and written communication skills and strong negotiation skills. Thrive in environments that celebrate co-creation and collaboration. Have high resilience - can manage yourself, your teams and your peers when faced with ambiguity or failure This could be the gig for you if you Are passionate about consumer behavior and culture; enjoy spending time with customers to understand what they want. Have an attentive ear to listen to new ideas. Join hands with other colleagues to solve for the customer. Like to work in a culture where everyone can see what others are doing. Take help from others when stuck and encourage others when there are setbacks. Take full responsibility for your team s contribution output while thinking wing-to-wing across the organization. Have strong clinical knowledge and clinical decision-making skills Have built best-in-class processes from scratch Are passionate about leveraging digital tools to transform customer experience

You could be the right candidate if you Have 5-6 years of experience in Travel Insurance operations and claims management with at least 2-3 years experience in lead/ equivalent role. Expert knowledge of Travel Insurance product features, process, regulatory and compliance requirements and implementation and management of comprehensive Travel insurance operations & claims management process. Aware of International Travel Insurance Medical Claims, terms & systems Understand the International Travel Insurance TPA ecosystem and have experience of managing TPA model Have startup experience or setting up a team from scratch (Preferred but not mandatory) Can make informed decisions, swiftly and are adept at creative problem solving; have good judgment and analytical skills Have excellent verbal and written communication skills and strong negotiation skills. Thrive in environments that celebrate co-creation and collaboration. Have high resilience - can manage yourself, your teams and your peers when faced with ambiguity or failure This could be the gig for you if you Are passionate about consumer behavior and culture; enjoy spending time with customers to understand what they want. Have an attentive ear to listen to new ideas. Join hands with other colleagues to solve for the customer. Like to work in a culture where everyone can see what others are doing. Take help from others when stuck and encourage others when there are setbacks. Take full responsibility for your team s contribution output while thinking wing-to-wing across the organization. Have strong clinical knowledge and clinical decision-making skills Have built best-in-class processes from scratch Are passionate about leveraging digital tools to transform customer experience

You could be the right candidate if you Have 5-6 years of experience in Travel Insurance operations and claims management with at least 2-3 years experience in lead/ equivalent role. Expert knowledge of Travel Insurance product features, process, regulatory and compliance requirements and implementation and management of comprehensive Travel insurance operations & claims management process. Aware of International Travel Insurance Medical Claims, terms & systems Understand the International Travel Insurance TPA ecosystem and have experience of managing TPA model Have startup experience or setting up a team from scratch (Preferred but not mandatory) Can make informed decisions, swiftly and are adept at creative problem solving; have good judgment and analytical skills Have excellent verbal and written communication skills and strong negotiation skills. Thrive in environments that celebrate co-creation and collaboration. Have high resilience - can manage yourself, your teams and your peers when faced with ambiguity or failure This could be the gig for you if you Are passionate about consumer behavior and culture; enjoy spending time with customers to understand what they want. Have an attentive ear to listen to new ideas. Join hands with other colleagues to solve for the customer. Like to work in a culture where everyone can see what others are doing. Take help from others when stuck and encourage others when there are setbacks. Take full responsibility for your team s contribution output while thinking wing-to-wing across the organization. Have strong clinical knowledge and clinical decision-making skills Have built best-in-class processes from scratch Are passionate about leveraging digital tools to transform customer experience

You could be the right candidate if you Have 5-6 years of experience in Travel Insurance operations and claims management with at least 2-3 years experience in lead/ equivalent role. Expert knowledge of Travel Insurance product features, process, regulatory and compliance requirements and implementation and management of comprehensive Travel insurance operations & claims management process. Aware of International Travel Insurance Medical Claims, terms & systems Understand the International Travel Insurance TPA ecosystem and have experience of managing TPA model Have startup experience or setting up a team from scratch (Preferred but not mandatory) Can make informed decisions, swiftly and are adept at creative problem solving; have good judgment and analytical skills Have excellent verbal and written communication skills and strong negotiation skills. Thrive in environments that celebrate co-creation and collaboration. Have high resilience - can manage yourself, your teams and your peers when faced with ambiguity or failure This could be the gig for you if you Are passionate about consumer behavior and culture; enjoy spending time with customers to understand what they want. Have an attentive ear to listen to new ideas. Join hands with other colleagues to solve for the customer. Like to work in a culture where everyone can see what others are doing. Take help from others when stuck and encourage others when there are setbacks. Take full responsibility for your team s contribution output while thinking wing-to-wing across the organization. Have strong clinical knowledge and clinical decision-making skills Have built best-in-class processes from scratch Are passionate about leveraging digital tools to transform customer experience

You could be the right candidate if you Have 5-6 years of experience in Travel Insurance operations and claims management with at least 2-3 years experience in lead/ equivalent role. Expert knowledge of Travel Insurance product features, process, regulatory and compliance requirements and implementation and management of comprehensive Travel insurance operations & claims management process. Aware of International Travel Insurance Medical Claims, terms & systems Understand the International Travel Insurance TPA ecosystem and have experience of managing TPA model Have startup experience or setting up a team from scratch (Preferred but not mandatory) Can make informed decisions, swiftly and are adept at creative problem solving; have good judgment and analytical skills Have excellent verbal and written communication skills and strong negotiation skills. Thrive in environments that celebrate co-creation and collaboration. Have high resilience - can manage yourself, your teams and your peers when faced with ambiguity or failure This could be the gig for you if you Are passionate about consumer behavior and culture; enjoy spending time with customers to understand what they want. Have an attentive ear to listen to new ideas. Join hands with other colleagues to solve for the customer. Like to work in a culture where everyone can see what others are doing. Take help from others when stuck and encourage others when there are setbacks. Take full responsibility for your team s contribution output while thinking wing-to-wing across the organization. Have strong clinical knowledge and clinical decision-making skills Have built best-in-class processes from scratch Are passionate about leveraging digital tools to transform customer experience

As a Third Party Administrator at HOSPITAL STAFF RECRUITMENT SERVICES, you will play a crucial role in managing various administrative tasks associated with health insurance claims while delivering exceptional customer service to patients. Your responsibilities will include processing health insurance claims accurately and efficiently, verifying patient information and eligibility, and engaging with insurance companies, healthcare providers, and patients to ensure smooth claim processing and resolution. You will be expected to maintain meticulous records, adhere to company policies and industry regulations, and collaborate with the team to achieve productivity and quality standards. Additionally, your role will involve addressing customer inquiries and concerns, identifying areas for process enhancement, and contributing to the overall efficiency of claims processing. The ideal candidate for this full-time position in Borivali, Maharashtra, India, will possess 1 to 3 years of experience as a Third Party Administrator in the healthcare industry, a strong understanding of TPA processes, familiarity with Mediclaim and cashless health insurance procedures, and excellent communication and organizational skills. If you are detail-oriented, customer-focused, and thrive in a fast-paced environment, we welcome you to join our team at HOSPITAL STAFF RECRUITMENT SERVICES and make a meaningful impact in the healthcare sector.,

Responsible for hospital empanelment, agreement coordination, maintaining relationships, supporting admissions/discharges, ensuring timely claim submissions, VIP support, and regular follow-ups for claim documents and health check requests for TPA.

Role & responsibilities Credit Cell Department Leadership : Lead and manage the Credit Cell department, overseeing day-to-day operations, staff performance, and ensuring efficient claim processing. Establish clear performance goals, KPIs, and targets for the Credit Cell team and track progress regularly Documentation and Compliance : Ensure checklist of each TPA/ Government institutions for claims are properly followed Develop and maintain strong relationships with external insurance providers, TPAs, Government Institutions and internal hospital departments Address and resolve complex issues between the hospital, insurance companies, and patients Ensure all dispatches are timely processed with proper documentation to TPA/ Government institutions Claim Management and Process Improvement: Ensure all insurance policies, claims, and pre-authorization requests are accurately handled Oversee the timely and accurate submission of insurance claims, ensuring compliance with hospital policies, insurance company requirements, and regulatory standards Review claim denials, underpayments, and delayed payments, and implement corrective actions to reduce issues Implement strategies to improve the approval rates of claims and streamline the claims submission process Ensure all Deductions and rejections at the time of settlement are properly addressed Financial Oversight and Revenue Optimization: Monitor the TPA claims and reimbursement process to ensure the hospital receives timely and full payments from insurance companies Track key metrics such as claim rejection rates, AR (Accounts Receivable) aging, and payment turnaround time to ensure revenue cycle efficiency Work closely with the finance team to ensure that insurance claims are processed correctly and that payment discrepancies are addressed Reporting & Documentation : Prepare and present detailed reports on TPA activities, including insurance claims status, pending approvals, rejections, & payments to senior management. Monitor key performance indicators (KPIs) such as claim approval rates, payment timelines, and patient satisfaction Maintain accurate documentation for audits and compliance checks, and ensure all claims and payments are tracked and recorded properly Dispute & Issue Resolution : Handle escalated insurance disputes, including denied or delayed claims, with insurance companies and patient Training and Knowledge Management : Regularly supervise, train, and mentor TPA staff to ensure they are up-to-date with industry practices, regulations, and hospital protocols Collaboration with Other Departments: Work closely with the finance, billing, and medical departments to ensure seamless integration of insurance-related processes within the hospitals overall operation Job Location: Jaipur

POSITION: MEDICAL OFFICER PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Bangalore Educational Qualification Shift BHMS, , BAMS, Pharm D Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. • • • Responsibilities Understand the process difference between PA and an RI claim and verify the necessary details accordingly. • Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff. • • Approve or deny the claims as per the terms and conditions within the TAT. • Handle escalations and responding to mails accordingly. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or deny the claims as per the terms and conditions within the TAT. Handle escalations and responding to mails accordingly. Work from Office only 1st Floor, H8M9+677, Block D, Noida Sector 3, Noida, Uttar Pradesh 201301 Interested candidates can share their resumes to WhatsApp to 9795919025

Role: Hospital Desk Executive Hospital Desk Executive will be the Single point of contact at the Hospital for the Medi Assist Raksha Prime Service. Roles and Responsibilities Close Coordination with the Hospitals and the Medi Assist Internal Stake Holders for patients best discharge experience. Collaborate with the operations team to ensure timely and accurate data processing. Ensure maximum discharges are happening through the Raksha Prime Services. Use relevant tools and MIS tools to organize data for reporting purposes. Qualification : Bachelor's/Masters Degree in the field of Pharmaceutical/Hospital Management/Medical Sciences/Insurance (but not Mandatory) Experience: 2-3 Years Experience Hospital/Medical/Health Insurance service. Candidates with experience in Hospital IP/OPD/Floor Management. Skill(s) required: Communication Skills (Written and Oral). Customer Centricity, Empathy. Basic Understanding of the Health Industry. MS Excel/Google Sheets. Mobile to go around multiple hospitals basis the business requirements.

Call on- 8588047050 Job Objective: To lead, develop, and implement marketing and business development strategies for the hospital with a focus on TPA coordination, corporate tie-ups, and patient acquisition. Key Responsibilities: TPA & Insurance Coordination: Maintain and strengthen relationships with Third Party Administrators (TPAs) and insurance companies. Ensure timely empanelment, renewals, and smooth coordination for cashless and reimbursement services. Liaison with billing and front office for pre-authorizations, approvals, and claim settlements. Corporate Tie-Ups & Business Growth: Develop and maintain relationships with corporate clients, government organizations, and PSUs. Organize corporate health camps and awareness programs. Create packages and proposals for corporate health checkups and OPD/IPD services. Marketing Strategy & Execution: Design and execute hospital branding and promotional activities. Handle digital marketing, social media, and offline campaigns to drive patient footfall. Monitor competitors and market trends for service positioning. Team Leadership & Coordination: Supervise the marketing team including executives and field staff. Allocate daily tasks and monitor team performance. Conduct training for staff related to TPA processes, corporate dealings, and soft skills. MIS & Reporting: Maintain monthly reports on revenue generated through TPA, corporate patients, and marketing activities. Track receivables and pending payments from TPA and corporate sources. Skills Required: Excellent communication and interpersonal skills Strong negotiation and networking abilities Knowledge of healthcare marketing, TPA procedures, and corporate operations Leadership and team management Analytical skills for data tracking and reporting Qualification & Experience: Graduate/Postgraduate in Marketing, Hospital Management, or related field 47 years of experience in healthcare marketing and TPA coordination

Job Description Acts as an interface between the TPA, Insurance Company and the hospital. Responsible for investigation of suspicious claims. Effective usage of Fraud control measures. Act as a backend support to the TPA. Responsible for data mining and analytics related to Fraud and Investigation (IFD) Field visit for investigation purpose. Client Servicing Responsible for developing the corporate customer base for MDIndia Health Insurance Services. Map the territory and maintain a strong pipeline of potential customers. Establish Contacts with key persons at the corporate and understand the current levels of Health Insurance services and needs. Develop strong relationship with Insurance Companies/Brokers. Promptly attending Emails, Phone calls, Whats App messages of Clients. Maintain proper MIS & Internal reports and present it to the management. Ability to work independently, achieve targets and be absolutely result oriented Open to travel. Desired Candidates Profile Qualification Any Graduate Experience Fresher - 2 Years Exp. Profile Executive Two wheeler is Mandatory If interested kindly share your resume to ta4@mdindia.com

Job title :- AM - IPD Billing & TPA (Deduction Recovery) To Manage the TPA/Insurance Agreement and tariff updation and coordinate with TPA Insurance for payment follow up along with max internal team as well for day-to-day work. Role & responsibilities To ensure customers TPA outstanding recovery within defined timelines. Achievement of assigned collection Targets. To maintain Insurance Tracker and updating of case status in E Prapti on weekly basis. Recovery of Top up deduction cases. TPA status of Outstanding cases prior to 30 days (Inclusive of Less than Rs. 10000). Bill docket receiving status prior to 30 days (Real time status basis on TPA records). Outstanding details to be shared with TPAs by 7th of every month. Relationship building with TPA key persons and arranging value added services across Pan max units. Working with TPAs networking/ Operation Managers to identify payout delay reasons and mitigate any issues being seen at TPA/MHC end. To provide NEFT dump to On Account team on fortnight/ Monthly basis. Resolution of On Account Team concerns/ requirements with in TAT of 72 hours. To capture correct status, TIN/CIN, Insurance Company name in Insurance Tracker. Post discharge Query resolution and updating in E Prapti. To identify reasons of wrong settlement cases and correction to be done with help of On-Account & Finance Team. Weekly report on action done against cheque Re Issue/paid by TPA but payout not received cases. Weekly TPA Visit Call Report. (Format already shared). On Account Settlement Prior to 90 days. Cashless Troubleshooting Assisting unit Front office/ Billing teams on day-to-day issues faced during hospitalization of patient. Data/ records maintaining of support extending to unit TPA teams for cashless troubleshooting cases. Maintaining relationship & regular visits to Pan Max units. Preferred candidate profile Qualifications - Graduate Experience - 3 to 5 years; Preferably with 2 years of healthcare experience Please share your CV deen.dayal@maxhealthcare.com

Designation-Executive/Team Lead in CRM for Client Servicing for Big Corporate. Job Location: Gurgaon, Haryana Industry-TPA Company or Health Insurance will only be preferred Job Description: Key Responsibilities: 1 . Management and Retention of Top corporate for the region along with Team as a L1 Level. 2. Reports on top corporate/insurance companies/brokers to be reviewed with Leadership Team and proactively act on issues before escalations. 3. Fulfilment of SLAs. 4. Oversee timely submission of MIS reports to Insurance Companies/Corporate etc.. 5.. Oversee department functions like the Customer Care, Claims, Preauth and related functions. 6.Claims and Cashless settlement 7. Coordination with Broker, Insurance Company and Corporate Client etc. Experience required: Experience: 2-5 years of experience in Customer Service or Client Relationship roles in Health Insurance or TPA Company Personal Attributes and Competencies: Strong verbal, written, presentation and persuasive skills that effectively communicates with Experience of making and developing strategies Strong negotiation skills that demonstrate creative, innovative problem-solving approaches to complex situations. Strong analytical and problem-solving skills. Interested Candidate can connect -09971006988

About 2070 Health 2070Health is Indias premier Venture Studio, pioneering an innovation platform dedicated to building groundbreaking healthcare companies from the ground up. Our mission is to identify and seize disruptive opportunities within the healthcare sector. What sets us apart from conventional venture capital and accelerator models is our active involvement in idea generation, day-to-day operations, and strategic decision-making, all geared toward fostering the growth of each newly established enterprise. Additionally, we are proud to have the steadfast support of W Health Ventures. About Everhope Oncology Everhope Oncology is on a mission to transform cancer care by making high-quality treatment more accessible, patient-friendly, and closer to home . Backed by Narayana Health , one of Indias leading hospital systems, W Health Ventures , a healthcare venture capital firm, and 2070 Health , a healthcare-focused venture studio, Everhope has secured $10 million in seed funding to establish a nationwide network of medical and surgical oncology facilities . Starting in Delhi and Mumbai , Everhope plans to expand to 10 cities over the next three years , bringing expert-led early diagnosis, daycare chemotherapy, and surgical oncology to locations where patients need them most. India faces a growing cancer burden, with over 150 million people expected to be diagnosed in their lifetime . Everhope is tackling this challenge head-on by creating smaller, strategically located centers that eliminate the logistical and emotional barriers to care . If youre passionate about shaping the future of oncology and want to be part of a high-impact, patient-first organization , join us in building a new era of cancer treatment one that prioritizes convenience, empathy, and innovation . Role Overview We are looking for an experienced and detail-oriented Compliance and Empanelment Lead to join our team at 2070Health. This role will play a critical part in ensuring that our healthcare initiatives comply with all relevant regulations and standards while also managing and optimizing the process of empanelment with service providers and partners. You will work closely with various stakeholders to develop and implement compliance strategies and frameworks that align with our organizational goals. Compliance: Ensure adherence to all statutory, legal, and regulatory healthcare compliances applicable to hospitals. Maintain accurate records of agreements, licenses, and statutory renewals. Coordinate with legal advisors and external authorities for audits, inspections, and assessments. Monitor compliance across departments and raise red flags for any deviation. Draft and review MoUs, contracts, and documents related to empanelment and partnerships. Empanelment Management: Drive and maintain empanelment with TPAs, corporates, PSUs, CGHS, ECHS, ESI, and other government/insurance bodies. Handle documentation, applications, follow-ups, and negotiations for new empanelments and renewals. Liaise with billing and recovery teams to ensure smooth claim settlements. Maintain updated rate lists, terms of empanelment, and communication logs. Work closely with hospital marketing and billing teams to improve patient footfall through empanelment channels. Recovery & Reporting: Track payment cycles and ensure timely follow-up with TPAs for claim settlements. Support in preparing monthly MIS reports on empanelment status, recovery, and pending dues. Coordinate with internal finance and audit teams on claim discrepancies and rectifications. Key Skills & Competencies: Strong understanding of hospital operations, TPAs, and regulatory frameworks. Effective communication and negotiation skills. Detail-oriented with strong documentation and organizational skills. Ability to coordinate across departments and manage external relationships. Knowledge of healthcare billing and audit processes. Qualifications & Experience: Bachelor s degree; LL.B preferred (as in Rajesh s case). Minimum 8 10 years of experience in empanelment, legal compliance, or hospital liaison roles. Prior experience with multispecialty hospitals or TPA/insurance sector is highly desirable.