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MEDI ASSIST INSURANCE TPA PRIVATE LIMITED
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Medical Officer- Non clinical

Medical Officer- Non clinical

MEDI ASSIST INSURANCE TPA PRIVATE LIMITED

0 years

3 - 4 Lacs

andheri mumbai maharashtra

Posted:4 days ago| Platform: SimplyHired logo

Apply

Skills Required

nursing b.sc bachelor's degree patient care in-person medical terminology

Work Mode

On-site

Job Type

Full Time

Job Description

Roles & Responsibilities:

Claim Processing: Verify the medical admissibility of a claim by confirming diagnosis and treatment details.
Claim Scrutiny: Scrutinize claims according to the terms and conditions of the insurance policy.
Data Interpretation: Interpret ICD coding, evaluate co-pay details, and classify non-medical expenses, room tariffs, and capping details. Differentiate between open billing and package deals.
Process Verification: Understand the process difference between a PA and an RI claim, and verify necessary details accordingly.
Document Verification: Verify all required documents for processing claims and raise an IR (Information Request) if documents are insufficient.
Team Coordination: Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of a tariff.
Claim Approval: Approve or deny claims as per the terms and conditions within the TAT (Turnaround Time).
Communication: Handle escalations and respond to emails promptly.

Interested candidates can share their resumes via email or WhatsApp:

Email: [email protected]
WhatsApp: 9632777628

Job Type: Full-time

Pay: ₹335,000.00 - ₹430,000.00 per year

Benefits:

Health insurance
Paid sick time
Paid time off
Provident Fund

Work Location: In person

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