Walk-in || Medical Officer
- Karthika Consulting
- 0 - 1 years
- Bengaluru
- 17 hours ago
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Job Description
Role & responsibilities
- Play as an intermediate role Between the Insurance co. and Hospital and We Assist Team.
- Adjudicating cashless and Reimbursement claims with claim documents provided by help desk executive.
- Should be able to do claim tabulation to bifurcate payable and non-payable items as per the terms and conditions laid out in the insurance policy.
- Evaluating claims and posting remarks in whats app group and updating in CRM.
- Monitoring billing as per the Tariff.
- Managing claims escalations from hospitals.
- Responsible to handling queries raised by insurance company / TPAs
- Provide technical assistance and conduct training sessions for new processors on various health insurance policies.
- Evaluate complete claim documents before submission.
- Final Approval of Tabulation done by the team
- Coordinate with Internal team to understand patient enquiries.
- Helping team to understand the Non-medical Items.
- Periodically educating claim assistance department about the changes in the policy, rules & regulations and application deduction on settlement.
- To create awareness about reimbursement claims. (Pre, Post & Hospitalization) and communicating the important updates to the Claims Assistance and Finance Department
- Be available at the office for supporting onsite staff on all six days in a week b/w 9.30am to 7.00pm
- Efficiently and effectively handle grievance / issue raised by hospital staff & patients, escalate issue to the team leader, Manager Insurance Adjudication and Business Head as necessary.
- Follow-up on the updates to be given to the clients / onsite team of Claims Assistance Department
Qualifications & Skills.
- BAMS / BHMS / BDS / Bsc / MSc / Nursing / Dpharm / Bpharm
- 5-8 years of relevant experience
- Should have good analytical skills
- Excellent interpersonal & communication skills
Experience.
- 5-8 years of experience in TPA or Indian Insurance claims or similar field or fresher
Additional Skills.
- Strong verbal skills Fluency
- Strong problem-solving skills and enthusiasm for new tasks and challenges
- Relationship building skills.
- Ability to multitask and prioritize, with a strong work ethic and attention to detail
- Ability to operate with a high level of confidentiality and professionalism
- A willingness to accept a high degree of uncertainty, jump in and help wherever needed, get hands dirty, and wear multiple hats on a fast-moving team.
- Should be able to manage the task assigned, while managing the tasks of the team/ team members that are assigned
- Should have an ability to manage and maintain smooth relationship with cross functional department such as Finance, Claims Assistance, Back-Office and Marketing Team
Job Classification
Industry: InsuranceFunctional Area / Department: Healthcare & Life SciencesRole Category: Health InformaticsRole: Medical Record / Health InformaticsEmployement Type: Walk-insContact Details:
Company: Karthika ConsultingLocation(s): Bengaluru+ View Contact
Keyskills: TPA medical officer Medical Insurance Claim Investigation Claims Processing Health Claims Insurance Claims Healthcare Insurance Claims Adjudication Health Insurance
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₹ 2-4 Lacs P.A
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