Job Description:

About company :

Falck (www.falck.com) for more than a century, has been helping people and societies to live in a safe and healthy environment. We are committed to advancing sustainable healthcare, and every step we take is dedicated to making life better, safer, and healthier. In a world of constant changes, peoples needs, and expectations keep evolving- except for the need for good health and feeling safe. Through our wide-ranging offers of healthcare and emergency health and safety services, we have made it our responsibility to help even more people around the world live healthy lives.

Job description:
- Ensure customer satisfaction of the highest order for all medical projects and services as assigned by the organization.
- Maintain and continually improve the quality of medical service delivery.
- Ensure that there is alignment and cooperation between medical team and operations team for seamless execution of designated projects and services.
- Scrutiny of medical documents and adjudication of the international travel insurance policy holders.




- Assess the eligibility of international travel insurance related medical claims and determine financial outcomes.
- Determine accuracy of medical documents.
- Processing the case as per policy terms & condition of the respective insurance companies.
- Coordinating & communicating with the other departments for processing the claim.
- Coordinating with insurance company for specific approvals.
- Handling the grievance related to the medical rejection/ denial of the Cashless request as well as re reimbursement claims.
- Providing the Quality services by keeping the minimum TAT.
- Involved in Analyzing Medical Reports to Process Medical Claims.
- Any other roles and responsibilities assigned form time to time related to the medical projects being managed by the organization beyond international travel insurance.

Education and experience: BAMS/BHMS having experience with TPA

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