· 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 Types: Full-time, Permanent, Fresher

Pay: ₹310,000.00 - ₹455,000.00 per year

Perks:

- Health insurance
- Paid sick time
- Provident Fund

Education:

- Bachelor's (Preferred)

Work Location: In person

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