Medical Officer - Bengaluru, Karnataka, India - MEDI ASSIST INSURANCE TPA PRIVATE LIMITED
Description
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 copay details, classify nonmedical 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.
This is a WFO (Work From Office) role only.
Salary:
₹270, ₹400,000.00 per year
Benefits:
- Health insurance
- Provident Fund
Schedule:
- Rotational shift
License/Certification:
- BAMS,BDS, MDS ,BHMS BPT MPT (required)
Work Location:
In person
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