Job Description:
- Managing repudiation and buffer approvals.
- Reopening and processing closed claims in case of incorrect repudiation, as per approval hierarchy.
- Ensuring closure of eligible claims through API integration wherever applicable.
- Process Corrections & Communication
- Identifying and correcting wrong processing at RFP or medical stage.
- Sending clarification and endorsement-related mails to IC when required.
- Coordinating with CRM teams and branches for payment status updates and claim-related communication.
- Grievance & Escalation Handling
- Handling grievance claims and escalation mails referred to IC regarding deductions or repudiated claims.
- Coordinating with internal stakeholders for resolution within defined timelines.
- Managing excluded hospital pop-ups and coordinating with provider team based on processing doctor’s inputs.
- API error related to provider – coordinate with IC
- BEM
- Co ordination with Enrolment Team
- APJ / RSA Integration & Error Resolution
- Addressing APJ integration errors including:
- Invalid hospital ID / employee ID
- Payee ID updating
- Incorrect ICD coding
- Missing or compressed documents
- Policy service data errors
- Denial reason not updated
- Approved amount mismatch etc.
- Following up on RSA claim numbers and ensuring system accuracy.
Job Types: Full-time, Permanent
Pay: ₹25,000.00 - ₹30,000.00 per month
Benefits:
- Health insurance
- Provident Fund
Work Location: In person
