Vidal Health is 100% Subsidiary of Bajaj Finserv Health (BFHL). Vidal Health Insurance TPA Pvt Ltd was established in March 2002 with the mission to provide top quality TPA services to Health Insurance policyholders and be the most preferred TPA in India. We are licensed by IRDA (Insurance Regulatory & Development Authority) and have been empanelled by leading insurance companies, both public sector and private, across different regions of the country.
Position Description:
The team of medical practitioner part of Pre-Auth team will use their skills and expertise in adjudicating the reimbursement received and they will ensure the same is attended on time by following the protocol of the policy defined by the insurer and the organization.
Roles and responsibilities:
- Dealing with patient’s health care related documents.
- Ensuring error free processing of reimbursement claims within agreed TAT (Turnaround time).
- Entering accurate information into the application defined by the organization.
- Review structured clinical data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures defined by the insurer and the organization.
- Any adjudication which is not as per the limit or as per the process to be escalated to the team manager on priority.
- Any medical opinion required from the specialist to be escalated to the specialist.
- Ensuring process compliance is met as per regulatory procedures.
- Maintaining Daily excel maintenance for reimbursement claim received and processed.
Skills and Competencies:
- Medical practitioner MBBS or equivalent qualification
- Year experience in Pre-Authorization and Clams management.
- Sound medical knowledge and willing to work in non-clinic process.
- Experience in handling authorization is a add on.
- Should be willing to work in shifts as per the requirements.
- Pre-Auth Shift Time: 9AM to 6PM, 11AM to 8PM, 4:30PM to 1:30AM & 3PM to 12AM.
- No. of working days: 5 (Pre-Auth Sat & Sun working and any 2 days will be leave).
- Training will be provided to fresher.
- Variable roster , in day shift to work from office .
📌 Pre-Auth-Medical Officer-VHC (India)
🏢 Vidal Healthcare Services
📍 India
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