Posted:1 day ago|
Platform:
Work from Office
Full Time
1. Along with the medical expertise, need to master the various products ( Policies) and to apply the terms and conditions during claim processing.
2. Claims processors process any claim payments when applicable and must ensure they comply with federal, state, and company regulations and policies.
3. To coordinate with various persons (Claimant, Treating Physician, Hospital insurance desk, Field Visit Drs, Investigation officers)for hassle-free claim processing
4. Medical claims processor will have to look into claims where payment was denied. Commonly due to issues of insurance coverage eligibility, the claims handler may be tasked with reviewing documentation from the patient, their physicians, or the insurance.
5. To validate the authenticity and the credibility of the claims.
6. To engage in the process of claim negotiation when necessitated.
7. The claim handler owes a duty of care to the patient, ensuring that their needs are being met and that theyre receiving the treatment or medicine they need.
8. Adapt and engage in the process of communication and coordination across the zones and the supporting verticals as required.
9. Attend Insurance Ombudsman hearings as well as medical opinion in complaint cases as required.
10. Engage in quality audits of claims as required.
Star Health Insurance
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