Medical Officer - Non Clinical

• 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.
• Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff.
• Approve or deny the claims as per the terms and conditions within the TAT.
• Handle escalations and responding to mails accordingly.

Job Type: Full-time

Pay: ₹340,000.00 - ₹400,000.00 per year

Benefits:

• Health insurance
• Paid sick time
• Paid time off
• Provident Fund

Application Question(s):

• Do you have a degree in BHMS / BAMS / BPT / BSc. Nursing?
• What is your current CTC?
• How many years of experience do you have?

Work Location: In person