Review the relevant medical information abstracted from medical records and then analyze the claim
Knowledge of US Insurance /Medical Claims/US Healthcare is preferable
In depth knowledge of medical terminology and body systems
Ability to interpret medical records, correlate clinical knowledge with available medical data to create medical summary as per product guidelines
Knowledge of Short and Long Term Disability will be an added advantage
Understanding of lifestyle disorders like diabetes, hypertension, obesity, etc. that complicates the normal line of treatment of fracture/pain/soft tissue injuries (helpful in creating treatment plan and recommendations)
Able to differentiate subjective and objective findings in medical records.
Education
Experience
Preferred medical education background -MBBS with Minimum 2 years of experience in reviewing medical records in claim process
Competencies
& Skills
Review of medical records and abstract relevant information
Identifying discrepancies, suspicious issues, negligence, and pre-existing comorbidities
Proficiency in written English and ability to paraphrase without altering the meaning of the medical text
Computer literacy - Basic IT knowledge and familiarity of operating systems (Windows)
Basic Knowledge of using Internet, web browser, search engine, Microsoft excel and word
Preferred Typing skills - 40 words per minute with 90% accuracy
Soft skills (Desired)
Adaptability
Eagerness to learn/flexibility to change
Openness to feedback
Team work
Business Awareness
Managing self
Customer focus
Desire to excel and improve
Self-motivated, team player
Problem solving skills
Analytical ability
Good Communication written and oral
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