Looking for freshers! * Processing of Cashless Requests & Health Insurance Claims for TPA / Insurance company * Process and Provide Medical opinion for Health Insurance Claims * Understanding of Claims adjudication / Claims Processing
* Processing of Cashless Requests & Health Insurance Claims for TPA / Insurance company * Process and Provide Medical opinion for Health Insurance Claims * Understanding of Claims adjudication / Claims Processing
Medical Officer responsible for reviewing and assessing medical claims, verifying documents, coordinating with hospitals, and ensuring accurate claim decisions as per policy and clinical standards. BAMS/BHMS preferred with TPA or insurance experience
Job Description: * Processing of Cashless Requests & Health Insurance Claims for TPA / Insurance company * Process and Provide Medical opinion for Health Insurance Claims * Understanding of Claims adjudication / Claims Processing * Understanding of Policy terms & conditions & Various Protocols / Guidelines, Ailment Wise ICD & Procedure Coding * Proficient with medical terms & computer usage Manage volumes effectively & efficiently to maintain Turnaround time of processing cases * Claim Case Management / Cost Management
Process claims payments as per defined schedules and procedures Assist in preparing Bank Reconciliation Statements (BRS) and MIS reports Monitor and ensure timely payments across assigned departments Proficiency in MS Excel, MS Office, and MS-SQL