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