- Review and assess IPD health insurance claims, including cashless pre-authorisation and reimbursement claims.

- Examine medical records, discharge summaries, investigation reports, prescriptions, and treatment details.

- Evaluate the medical necessity and appropriateness of hospitalization and treatment.

- Verify diagnosis, procedures, length of stay, and medical expenses against policy coverage.

- Identify discrepancies, missing documents, possible overbilling, and non-payable medical expenses.

- Assess claims based on policy terms, exclusions, waiting periods, and applicable guidelines.

- Provide medical opinions and recommendations for claim approval, query, or rejection, as per delegated authority.

- Coordinate with hospitals, insurance companies, and internal claims processing teams for clarifications and additional documents.

- Ensure claims are processed within the prescribed turnaround time (TAT).

- Maintain accurate claim assessment records and comply with internal quality standards and regulatory requirements.

📌 IPD Claims - kochi (India)
🏢 Vidal Health Insurance TPA
📍 India