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24/07 Strategic Alliance Management Services
HR Consulting at Strategic Alliance Management Services

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Senior Consultant - Claims - National Health Authority (3-8 yrs)

Delhi Job Code: 836166

1. POSITIONS VACANT : Senior Consultant (Claims), SCON-C, National Health Authority (NHA), MoHFW, GoI (One Vacancy)

2. ORGANIZATION BACKGROUND :

National Health Authority (NHA) is the apex body, responsible for implementing Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), India's flagship health assurance scheme, providing health cover of Rs. 5 lakhs per family, per year, for secondary and tertiary care hospitalization, to over 10.74 crore poor and vulnerable families, or approximately 50 crore beneficiaries.

NHA is tasked with implementing PM-JAY at the national level.

State Health Agencies (SHAs) have been instituted by concerned states to implement PM-JAY at the state level. SHAs have full operational autonomy to implement PM-JAY in their state.

Key Functions of NHA :

Key functions of the NHA include the following :

(1) Formulation of operational guidelines, model documents and contracts, to ensure standardization and interoperability of PM-JAY;

(2) Effective implementation and regular monitoring of PM-JAY, across the country, including initiation of suitable action for course correction, as necessary;

(3) Coordination with various State Governments on a regular basis for implementing PM-JAY;

(4) Acting as an apex body for SHAs that have been set up to implement PM-JAY.

For more information about NHA, please visit https://pmjay.gov.in/about/nha

3. JOB DESCRIPTION/ RESPONSIBILITIES :

Reporting to the General Manager (Operations), the Senior Consultant (Claims), shall be responsible for conducting claim adjudication/ audit by designing and strengthening claims audit tools.

Key Responsibilities :

(1) Create and strengthen claims audit tools and modules to enable the conduct of effective desk and field claims audits;

(2) Conduct claims audits;

(3) Analyse various dashboards, triggers and outliers to identify cases for claims audits;

(4) Prepare weekly, monthly and yearly reports, as and when required;

(5) Prepare and share reports indicating suggested corrective actions;

(6) Any other assignment/ responsibility given by NHA.

4. QUALIFICATION, SKILLS AND EXPERIENCE :

Qualifications :

Essential :

- Bachelor's degree from a recognized University /Institute.

Desirable :

- Graduate or post degree in medicine or public health shall be an advantage.

Experience :

Essential :

- Three years of experience in TPA monitoring, claims adjudication and/or audit of health insurance claims.

Desirable :

- Experience in Insurance/ TPA operations in Claims Adjudication/ Audit.

Skills and Competencies :

(1) Ability to identify fraud and mismanagement in the process;

(2) Strong verbal and written communication and presentation skills;

(3) Computer literate with knowledge and experience of MS office, Excel and Power point;

(4) Proficient in drafting notes and letters in English and Hindi with focus on spelling, punctuation, grammar and other language skills;

(5) Demonstrable language proficiency skills in English and Hindi;

(6) The job may require frequent travelling hence the candidate should be willing to travel.

5. VACANCY DETAILS : One vacancy

6. AGE LIMIT :

- Not less than 25 years and not exceeding 40 years, as on the last date for receiving applications.

7. COMPENSATION OFFERED :

Gross remuneration budgeted for the position is Rs. 1,00,000/- per month.

8. LOCATION : New Delhi, NHA Office.

9. CONTRACT TYPE AND PERIOD :

The post-holder shall be engaged on a consultancy contract, initially for a period of 12 months, extendable thereafter, on the basis of performance and approval by NHA.

10. REFERENCE: CON-HNQA


11. CONTACT INFORMATION:


Team SAMS

Strategic Alliance Management Services P Ltd.

1/1B, Choudhary Hetram House, Bharat Nagar

New Friends Colony, New Delhi 110 025

Phone Nos.: 011-41011564/65; 4081 990


12. LAST DATE FOR APPLICATIONS :


Eligible candidates interested in this position are requested to apply online at www.sams.co.in by or before August 16, 2020, 11:59:59 PM.


CORRIGENDUM :


The last date for receipt of completed application forms for the vacancy is extended up to August 16, 2020 (11:59:59 PM). Other terms and conditions related to the application process remain unchanged.


Please Note : Only information input by candidates into their online application form, shall be considered for the purposes of confirming eligibility and assessing their candidature. The CV document uploaded by candidates shall be considered to comprise supplementary information, only. Requests by candidates to consider supplementary information provided in the CV document for the purposes of determining eligibility or awarding assessment scores shall not be entertained. Applications submitted through non-online modes, shall be deemed invalid.

Women-friendly workplace:

Maternity and Paternity Benefits

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