Posted:3 hours ago|
Platform:
On-site
Full Time
Medical Claims Review:
Analyze and assess pre-authorization and post-treatment reimbursement claims.
Review medical records, diagnosis, investigation reports, and treatment plans to ensure clinical appropriateness and policy alignment.
Validate claims based on insurance policies, internal guidelines.
Decision Making:
Determine the admissibility or rejection of claims and recommend the claim amount.
Coordinate with claims team and finance for timely claim settlements.
Communication & Coordination:
Liaise with hospitals, policyholders, and internal teams to clarify documentation or medical details.
Provide medical inputs to customer support or grievance redressal teams when needed.
Documentation & Reporting:
Maintain accurate and updated documentation of all reviewed cases.
Support audit and compliance processes by ensuring claims are processed with proper medical justification.
Quality & Compliance:
Ensure adherence to TATs (Turn Around Times) and SLAs (Service Level Agreements).
Maintain confidentiality and handle sensitive health data in compliance with data protection regulations.
Job Type: Full-time
Pay: ₹30,000.00 - ₹35,000.00 per month
Work Location: In person
Paramount Healthcare Management Pvt Ltd
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