Role & 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

Preferred candidate profile

- Error-free processing (100% Accuracy)

- Maintaining TAT

- Productivity (Achieve the daily targets)

📌 Medical Officer - Bangalore (Bengaluru)
🏢 Medi Assist
📍 Bengaluru