Designation: Medical Officer

Function: Claims PA/RI Approver

Location: Chennai

Educational Qualification

BHMS,BAMS,

Industry Type: Hospital/TPA/Healthcare/Insurance

Roles and Responsibilities:

· 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.

Key Results and Outcomes driven by this role:

· Error-free processing (100% Accuracy)

· Maintaining TAT

· Productivity (Achieve the daily targets)

Relevant Experience:1- 2 years

No of years of experience:1-3 years

Technical Competencies:

· Analytical Skills

· Basic Computer knowledge

· Type writing skills

Behavioural competencies:

· Communication skills

· Decision Making

contact no : +91-XXXXXXXXXX shenbagam

Job Type: Full time

Pay: ₹300,000.00 - ₹400,000.00 per year

Education:

- Bachelor's (Required)

Experience:

- total work: 1 year (Preferred)

Work Location: In person

📌 Medical Officer (India)
🏢 MEDI ASSIST INSURANCE TPA PRIVATE
📍 India