Deputy General Manager - TPA - Medical Services Provider

- Ensuring timely completion of all internal deliverables and maintaining MIS, reports, etc for management information purpose.

- Handling investigation and fraud detection in health and personal accident claims.

- Responsible for maintaining strong relationship with TPA and Insurance Companies.

- Liaison for smooth flow of pre-authorization request for all corporate and retail health policies

- Liaison for effective cashless and reimbursement claim process

- Liaison with external TPAs for timely processing of cashless and reimbursement claims

- Involved in TPAs claims audit and maintaining Service Level Adherence with them

- Monthly claims review meeting with clients & TPAs.

- Handling settlement TATS

- Monitoring of retrieval claims, and quality control

- Monitoring TPAs function to ensure quality & accuracy in cashless & reimbursement claim settlement

- Strictly maintaining Service Level Adherence and complaint management with the teams end with good and timely coordination

- Handling all audits internal or client requested