Medical Officer

Medi Assist

Posted: 2 months ago
Openings: 10
Applicants: 0

Job Description

BAMS, BHMS, B Sc. Nursing MBBS (India Reg Mandatory)

Purpose of role:

To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms conditions while applying their domain medical knowledge.

Roles and Responsibility

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.
Approve or deny the claims as per the terms and conditions within the TAT.
Handle escalations and responding to mails accordingly

Key Results and Outcomes driven by this role: