Medical Officer - Cashless

Dear Candidates,

Greetings from HealthIndia Insurance TPA Service Pvt. Ltd.

Company Profile -

For more details kindly go through company website: https://www.healthindiatpa.com

Claim Processing Department

Location:

406-412, Neelkanth Corporate IT Park, 4th Floor, Kirol Road/ Village,

Vidyavihar (West), Mumbai 400086.

Key Responsibilities:

• Review and assess medical documents for insurance claims.
• Verify authenticity of medical reports and diagnostics
• Evaluate medical necessity as per policy terms
• Offer expert opinions on complex/disputed cases
• Collaborate with internal teams for seamless claim processing
• Identify potential fraud or discrepancies
• Liaise with providers and clients for additional inputs
• Maintain accurate medical evaluation records
• Stay updated with medical and regulatory developments
• Contribute to training and knowledge sharing.
• Reviewing and processing pre-authorization requests for cashless hospitalization, ensuring all necessary documentation is in order.
• Analyzing medical records and reports to verify the legitimacy of claims and assess the need for further investigation.
• Interacting with hospitals, insurance companies, and patients to address queries, resolve discrepancies, and facilitate claim approvals.
• Maintaining accurate records of all claim-related interactions and ensuring proper documentation for both cashless and reimbursement claims.
• Ensuring adherence to established guidelines, policies, and regulations related health insurance claim processing.

Strong written and verbal communication skills, with flexibility to work rotational shifts.

roshni.rajbhar@healthindiatpa.com

Roshni Rajbhar

HR Team,

roshni.rajbhar@healthindiatpa.com

8976760162