Job Description

Roles and responsibilities - Medical Doctor Freshers not preferred Processing of health claims as per SOP/guidelines shared, Day-to-day achievement of expected productivity without compromising on the quality parameters. Identification of Fraud triggers and possible leakage Complete understanding of health claims processing Aware of latest regulations and their implications Adherence to the prescribed TATs for each category Thorough medical knowledge, clinical efficacy of the treatment protocols given Able to read, interpret and question the information on the medication and relation to the diagnosis Clear understanding on ICD code and procedure codes Case management where there is possibility of inflation/abuse Interpretation of the product wordings for appropriate claims decision