Medical Officer- Non clinical (Pune)
- Medi Assist
- 0 - 2 years
- Mumbai
- 2 months ago
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Job Description
POSITION: MEDICAL OFFICER/CONSULTANT PA/RI APPROVER
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.
Designation : Medical Officer/Consultant
Function : Claims PA/RI Approver
Reporting to : Assistant Manager Claims
Location : Mumbai
Educational Qualification : BHMS, Bsc Nursing , BAMS, BPT, MBBS
Shift : Rotational Shift (for female employee shift ends at 8:30 PM)
Week offs : 6 rotational week offs Provided per month
Management Level : Junior Management Level
Industry Type : Hospital/TPA/Healthcare/Insurance
Roles and 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.
Key Results and Outcomes driven by this role:
- Error-free processing (100% Accuracy)
- Maintaining TAT
- Productivity (Achieve the daily targets)
Relevant Experience : 0- 2 years
No of years of experience : 0-2 years
If interested, please share your CV on:
Mail: ab************a@me*******t.in
Whatsapp: 8050700***
Job Classification
Industry: InsuranceFunctional Area / Department: Healthcare & Life SciencesRole Category: DoctorRole: Doctor - OtherEmployement Type: Full timeContact Details:
Company: Medi AssistLocation(s): Mumbai
Keyskills: Bpt Nursing BHMS BAMS OPD Ayurveda TPA General Medicine Homeopathy Medicine Bds Mediclaim Pharmacy Investigation Medical Hospital
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