Consultant - Medical Officer - Mumbai
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Only for registered members Mumbai, India
1 month ago
Job summary
Hiring Medical officer for Insurance Claim processing Profile. 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.
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 nonavailability of tariff.
- Approve or deny the claims as per the terms and conditions within the TAT.
Job description
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