Designation: Medical Officer
Function: Claims PA/RI Approver
Location: Bangalore
Educational Qualification
BHMS,BAMS, MBBS.
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:0-3 years
Technical Competencies:
· Analytical Skills
· Basic Computer knowledge
· Type writing skills
Behavioral competencies:
· Communication skills
· Decision Making
Job Type: Full-time
Pay: ₹300,000.00 - ₹350,000.00 per year
Education:
Experience:
- total work: 1 year (Preferred)
Work Location: In person
