· 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.
Job Types: Full-time, Permanent, Fresher
Pay: ₹310,000.00 - ₹455,000.00 per year
Benefits:
- Health insurance
- Paid sick time
- Provident Fund
Education:
Work Location: In person
