Job description

Check the medical admissibility of a claim by confirming the diagnosis and treatment details.
Scrutinize the claims as per the terms and conditions of the insurance policy
Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiate open billing and package, etc.
Understand the process difference between PA and an RI claim and verify the necessary details accordingly.
Verify the required documents for processing claims and raise an IR in case of an insufficiency.
Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff.
Approve or deny the claims as per the terms and conditions within the TAT.
Handle escalations and respond to emails accordingly.

Interested candidates can share their CVS to [email protected] or WhatsApp on 6366422910.

Role: Medical Officer
Industry Type: Insurance
Department: Healthcare & Life Sciences
Employment Type: Full Time, Permanent
Role Category: Doctor

Education
UG: BHMS in Homeopathy, BAMS in Ayurveda, B.Sc in Nursing
PG: MS/M.Sc(Science) in Nursing

Key Skills
BSC Nursing Msc Nursing medical Knowledge
insurance BHMSTPA Experience Medical Officer BAMS Claims Adjudication Claims Processing