1] Handling health claims/Cashless reimbursements as per the prescribed manner within the TAT
2] Verification of medical documents for justification of claims
3] Good in medical knowledge and hospital practice exposure
4] Fraud control by identifying existing claim trends & triggers management.
5] Scrutiny of Health claim as per Financial Liability, in consideration with Existing provider Tariffs.
6] Co-ordination with TPA &Insurance Company. 7] Handling the grievance related to the rejection/ denial of the Cashless request as well as re-reimbursement claims.
Skills & Competencies required for the Role: Good Medical knowledge with claim judgment
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