· 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, differentiation of 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 responding to mails accordingly.

Job Type: Full time

Pay: ₹270,000.00 - ₹420,000.00 per year

Perks:
Health insurance
Paid sick time
Provident Fund

Application Question(s):
Do you have a degree in BHMS/BAMS/Bsc Nursing
Are you available to join within 7 days
Current CTC
Expected CTC

Work Location: In person

📌 Medical Officer Non Clinical Bengaluru
🏢 MEDI ASSIST INSURANCE TPA PRIVATE
📍 Bengaluru