OperationsEmployee StatusTrainee / Probation / ConfirmedReporting To
Date Last Reviewed
Roles & Responsibilities:
- Claims processing: Handle and process both cashless and reimbursement claims from hospitals and patients.
- Document verification: Scrutinize medical documents, cross-check diagnoses with treatment details, and request necessary information from treating doctors or patients.
- Pre-authorization: Send pre-authorization requests to insurance companies for cashless claims and obtain approvals.
- Policy adherence: Review claims against policy terms and conditions to determine final adjudication decisions.
- Stakeholder communication: Liaise with hospitals,
doctors, and insurance companies to ensure smooth operations and resolve queries.
- Grievance handling: Effectively address and resolve grievances from policyholders.
- Administrative support: Assist with general administrative tasks within the TPA department to ensure effective workflow.
- Data entry and management: Maintain accurate records and files related to claims and policyholder information.
* Responsibilities can be modified subject to necessity. Employee Signature Head Operations Head - HR