Healthcare Jobs in Pune
We maintain a corporate culture and are committed to excellence in our endeavours. We think as innovators, act as solution providers, collaborate as partners, work as outperformers. We believe in teamwork, employee engagement & employee empowerment. At Manorama the best practices are rewarded in business, from strategy to team leadership, influence, innovation, product management, and client services. We train our team to revamp their skills and competency for better administration and operations.
We are an equal opportunity employer, supporting diversity, equality & dignity. We have best of talents and skilled team working for our Organisation. We have multiple openings for various roles in our organisation. We welcome go getters with passion for creativity, talent to explore, zeal for excellence and most importantly a passion for IT.
commercial, federal and state government plans specifically support operational
processes for provider data management functions, enrollment and eligibility,
member benefits, claims adjudication and EDI Interfaces functions.
• Knowledge of State regulations to determine provider meets qualification to be
• Knowledge of provider files from State Medicaid programs to decipher provider
enrollment and eligibility rules.
• Knowledge of provider type designation identified by the State Medicaid programs.
• Knowledge of provider and member portal functions.
• Knowledge of provider reimbursement methodologies about Commercial, CMS and
State defined guidelines.
• Knowledge of provider matching criteria for claims.
• Knowledge of Coordination of Benefits (COB) and Claim Authorizations functions.
• Knowledge of Setting up communications for EDI transmissions using FTP, SFTP and
real time API setups
• Knowledge of health insurance, HMO and managed care principles including
Medicaid and Medicare regulation.
• Solid analytical skills with the ability to compile data from many sources and define
designs for enrollment to benefit plan configuration.
• Research, interpret and summarize new state, federal and client rules regarding
department functions. Alter or create policies and procedures to adhere to those
• Solid communication skills with working session facilitation.
• Strong time management, attention to detail, analytic and organizational skills.
• Excellent interpersonal, oral and written communication skills.
• Able to work independently and within a collaborative team environment with little
In-depth knowledge in Healthcare and BPaaS domain, Good understanding in Delivery Excellence Framework, Expertise in business and IT processes, platforms, operations, controls and dependencies Secondary Skills: Intermediate to Expert proficiency in conducting audits & assessments in BPaaS domain areas, Proficiency in building, monitoring and testing controls for BPaaS
- Provide facilitation to ensure noiseless delivery and enable best practices adoption & evangelization through appropriate processes and platforms
- Solution consultant for projects to adopt right tools and measure to ensure product & service quality in the appropriate service lines
- Ensure effective governance of projects and deliverables
- Proactive risk management and mitigation, build known risks database to identify and mitigate risks proactively and establish oversight to monitor quality, targets and spending on implementation plan
- Enabling and co-working with the accounts / projects in compliance of regulatory requirements, other certification requirements of the Organization and the Customers for BPaaS domain. Support closure of external/internal audit findings, RCA/CAPA/FMEA for escalations
- Establish Integrated Risk and Delivery Governance models, and oversight to monitor quality, targets, overrun and penalty
- Build process mapping for BPaaS describing the high level activities across Product Service Lines establish ETVX, role definition, gating criteria, SLAs, OLAs and RACI
- Design and ensure operational and compliance controls are implemented, tested and monitored
- Build core competency to carry out DEx BPaaS audits and assessments