Medical Officer - Reimbursement & Cashless

0 - 2 years

2 - 4 Lacs

gurugram bengaluru mumbai (all areas)

Posted:2 weeks ago| Platform: Naukri logo

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Job Type

Full Time

Job Description

  • Review and assess medical documents for insurance claims.
  • Verify authenticity of medical reports and diagnostics
  • Evaluate medical necessity as per policy terms
  • Offer expert opinions on complex/disputed cases
  • Collaborate with internal teams for seamless claim processing
  • Identify potential fraud or discrepancies
  • Liaise with providers and clients for additional inputs
  • Maintain accurate medical evaluation records
  • Stay updated with medical and regulatory developments
  • Contribute to training and knowledge sharing.
  • Reviewing and processing pre-authorization requests for cashless hospitalization, ensuring all necessary documentation is in order.
  • Analyzing medical records and reports to verify the legitimacy of claims and assess the need for further investigation.
  • Interacting with hospitals, insurance companies, and patients to address queries, resolve discrepancies, and facilitate claim approvals.
  • Maintaining accurate records of all claim-related interactions and ensuring proper documentation for both cashless and reimbursement claims.
  • Ensuring adherence to established guidelines, policies, and regulations related health insurance claim processing.

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HealthIndia Insurance TPA Services logo
HealthIndia Insurance TPA Services

Insurance/TPA Services

Mumbai

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