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For Employers

Medical Officer

Name: Jobpe
Address: T-Hub, Plot No 1/C, Sy No 83/1, Raidurgam panmaktha, Knowledge City Rd, Hyderabad, Telangana, 500081, IN
Telephone: +91-83339-09630
Price range: Free

NEXTENTI TECH PRIVATE LIMITED

0 - 2 years

2 - 6 Lacs

bengaluru

Posted:7 hours ago| Platform:

Apply

Skills Required

medical insurance handle escalations mbbs analytical skills communication skills writing skills

Work Mode

Work from Office

Job Type

Full Time

Job Description

PURPOSE OF ROLE:

To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge

KEY RESPONSIBILITY:

Check the medical admissibility of a claim by confirming the diagnosis and treatment details

Scrutinize the claims, as per the terms and conditions of the insurance policy

Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc

Understand the process difference between PA and an RI claim and verify the necessary details accordingly

Verify the required documents for processing claims and raise an IR in case of an insufficiency

Approve or deny the claims as per the terms and conditions within the TAT

Handle escalations and responding to mails accordingly

KEY RESULTS AND OUTCOMES DRIVEN BY THIS ROLE:

Error-free processing (100% Accuracy)

Maintaining TAT

Productivity (Achieve the daily targets)

TECHNICAL COMPETENCIES & BEHAVIOURAL COMPETENCIES:

Analytical Skills

Basic Computer knowledge

Type writing Skills

Communication Skills

Decision Making

Qualification
BHMS Bachelor of Homeopathic Medicine and Surgery, BAMS Bachelor of Ayurvedic Medicine and Surgery, MBBS in Russia, MBBS in Ukraine

Department
Claims

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Medical Officer