- Play as an intermediate role Between the Insurance co. and Hospital andWe AssistTeam.
- Adjudicatingcashless and Reimbursement claims with claim documents provided by help desk executive.
- Should be able to do claim tabulation to bifurcate payable and non-payable items as per the terms and conditions laid out in the insurance policy.
- Evaluating claims and posting remarks inwhatsapp group and updating in CRM.
- Monitoring billing as per the Tariff.
- Managingclaimsescalations from hospitals.
- Responsibletohandlingqueriesraised by insurance company / TPAs
- Provide technicalassistanceand conduct training sessions for current processors on various health insurance policies.
- Evaluate complete claim documents before submission.
- Final Approval of Tabulation done by the team
- Coordinate withthe Internalteam to understand patient enquiries.
- Helping team to understand the Non-medical Items.
- Periodically educatingthe claimassistancedepartmentaboutthe changes in the policy, rules ®ulationsand; applicationdeduction on settlement.
- To create awareness about reimbursement claims. (Pre, Post & Hospitalization)and communicating the important updates to the Claims Assistance and Finance Department
- Be available at theoffice for supporting onsite staffon allsix days in a week b/w 9.30am to7.00pm
- Efficiently and effectively handle grievance / issue raised by hospital staff & patients, escalateissueto theteam leader,Manager Insurance Adjudicationand BusinessHeadas necessary.
- Follow-upon the updates to be given to the clients/ onsite team of Claims Assistance Department
Qualifications & Skills
- BAMS / BHMS/ BDS /Bsc/ MSc / Nursing/Dpharm/Bpharm
- 0 -2yearsofrelevantexperience
- Should have good analytical skills
- Excellent interpersonal & communication skills
Experience 0-2years of experience inTPAorIndianInsuranceclaimsor similar fieldor fresher
Additional Skills
- Strong verbal skills Fluency
- Strong problem-solving skills and enthusiasm for new tasks and challenges
- Relationship building skills.
- Ability to multitask and prioritize, with a strong work ethic and attention to detail
- Ability tooperatewitha high levelof confidentiality and professionalism
- A willingness to accept a high degree of uncertainty, jump in and help wherever needed, get hands dirty, and wear multiple hats on a fast-moving team.
- Should be able to manage the task assigned, while managing the tasks of the team/ team members that are assigned
- Should haveanability to manage andmaintainsmoothrelationshipwith cross functionaldepartmentsuch as Finance, Claims Assistance, Back-Officeand Marketing Team