Medical Officer

Role & responsibilities

• Play as an intermediate role Between the Insurance co. and Hospital and We Assist Team.
• Adjudicating cashless and Reimbursement claims with claim documents provided by help desk executive. 
• Should be able to do claim tabulation to bifurcate payable and non-payable items as per the terms and conditions laid out in the insurance policy.
• Evaluating claims and posting remarks in whats app group and updating in CRM. 
• Monitoring billing as per the Tariff.
• Managing claims escalations from hospitals.
• Responsible to handling queries raised by insurance company / TPAs
• Provide technical assistance and conduct training sessions for new processors on various health insurance policies.
• Evaluate complete claim documents before submission.
• Final Approval of Tabulation done by the team
• Coordinate with Internal team to understand patient enquiries. 
• Helping team to understand the Non-medical Items.
• Periodically educating claim assistance department about the changes in the policy, rules & regulations and application deduction on settlement.  
• To create awareness about reimbursement claims. (Pre, Post & Hospitalization) and communicating the important updates to the Claims Assistance and Finance Department
• Be available at the office for supporting onsite staff on all six days in a week b/w 9.30am to 7.00pm
• Efficiently and effectively handle grievance / issue raised by hospital staff & patients, escalate issue to the team leader, Manager Insurance Adjudication and Business Head as necessary.
• Follow-up on the updates to be given to the clients / onsite team of Claims Assistance Department

Qualifications & Skills.

• BAMS / BHMS / BDS / Bsc / MSc / Nursing / Dpharm / Bpharm
• 5-8 years of relevant experience
• Should have good analytical skills
• Excellent interpersonal & communication skills

Experience.

• 5-8 years of experience in TPA or Indian Insurance claims or similar field or fresher 

Additional Skills.

• Strong verbal skills Fluency 
• Strong problem-solving skills and enthusiasm for new tasks and challenges
• Relationship building skills.
• Ability to multitask and prioritize, with a strong work ethic and attention to detail
• Ability to operate with a high level of confidentiality and professionalism
• A willingness to accept a high degree of uncertainty, jump in and help wherever needed, get hands dirty, and wear multiple hats on a fast-moving team.
• Should be able to manage the task assigned, while managing the tasks of the team/ team members that are assigned
• Should have an ability to manage and maintain smooth relationship with cross functional department such as Finance, Claims Assistance, Back-Office and Marketing Team