Hospital Administrator - Hospital (1-14 yrs)
Role: Hospital Administrator
Type: Full Time
Roles and Responsibilities
- Ensure an effective and efficient Claims facilitation process and accountable for appropriate job allocation and coordination amongst the team.
- Monitor the productivity of the Data Management Services team by ensuring that Claims (cashless /reimbursement) received at Branch/Zone are uploaded on daily basis along with the important documents.
- Monitor escalations from customers/clients being reported by interacting with respective Zonal/Corporate Medical team and ensure grievance process is precisely implemented by the nominated grievance officers.
- Supervising and monitoring all legal issues relating to claims including Ombudsman /Consumer forum.
- Effectively communicate claim control measures to the Operating Offices and ensure that they are implemented.
- Keep track on sudden inflow of claims from any particular non-tertiary care hospitals and try to get confidential report about such hospitals and keep the Vigilance team informed.
- Hold regular meeting of TPA desk officers of Network hospitals.
- Monitor total cash-flows to hospitals and ensure that we get maximum early payment discount / avoid no penal interest paid for delayed payments.
- Keep track on working of FVR activities and ensure that same FVR doctor is not sent regularly to any one hospital.
- Attend meeting with various Marketing teams to understand market trends/customer grievances/ and ensure they are addressed.
- Coordinate with CMU for any underwriting related issues escalated to Zonal Office.
- Periodic meeting with Regional Vigilance Officers and guide them on carrying out effective investigation.
- Any other responsibility as deemed fit by the Management.