Title Medical Assessor

As a Medical Doctor, you will be responsible for processing health claims in accordance with the standard operating procedures and guidelines provided. Your primary focus will be on achieving daily productivity targets while upholding quality standards. Your role will involve identifying potential fraud triggers and areas of possible leakage. It is essential for you to have a comprehensive understanding of health claims processing, staying updated on the latest regulations and their implications. Adherence to the specified turnaround times for each category is crucial. Your role will also require a solid foundation in medical knowledge and clinical efficacy of treatment protocols. You should possess the ability to analyze medication information in relation to the diagnosis, as well as a clear understanding of ICD and procedure codes. Case management skills will be necessary in situations where there is a risk of inflation or abuse. Additionally, you will need to interpret product wordings to make appropriate claims decisions.,