Role: Hospital Administrator

Type: Full Time

Job Description

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.