Job Description

JOB PURPOSE To assist clinical research teams and often help training and supporting the sales force. To provide an authoritative opinion regarding medical based questions, legal and regulatory matters thus enabling colleagues to comply with the required statutory requirements. PRINCIPAL ACCOUNTABILITIES \xc2\xb7 Scrutiny of files to determine if the claims do really qualify to be reimbursed or to be settled. \xc2\xb7 To determine if the amount of the claims requested fits into SOC (Schedule of Charges) or PPN criteria \xc2\xb7 To verify if all the investigation reports have been submitted along with the claims \xc2\xb7 To make sure that intimation is received from the patient depending upon the type of claim i.e. cashless or non cashless (Claims Intimation) \xc2\xb7 To verify if all the document submission has been completed in time by the patients(Claim Document Submission). \xc2\xb7 Answering patient queries regarding status of claims \xc2\xb7 Answering queries regarding grievance requests raised by patients or hospitals. \xc2\xb7 Scrutiny of files to determine if the claims do really qualify to be reimbursed or to be settled. \xc2\xb7 To determine if the amount of the claims requested fits into SOC (Schedule of Charges) or PPN criteria \xc2\xb7 To verify if all the investigation reports have been submitted along with the claims. \xc2\xb7 To make sure that intimation is received from the patient depending upon the type of claim i.e. cashless or non cashless (Claims Intimation) \xc2\xb7 To verify if all the document submission has been completed in time by t he patients(Claim Document Submission) QUALIFICATIONS AND SKILLS \xc2\xb7 Must have experience of 2-5 years \xc2\xb7 BDS in Any Specialization, BAMS in Any Specialization, BHMS in Any Specialization, B.U.M.S in Any Specialization \xc2\xb7 Must have effective communication skills \xc2\xb7 Candidate must have sound knowledge about claims hospitals and TPA. \xc2\xb7 Excellent diagnostic skills using clinical knowledge and x-rays. \xc2\xb7 Excellent knowledge about Insurance policy terms and conditions \xc2\xb7 Good knowledge about medical admissibility of claims, clinical practices and protocol \xc2\xb7 Excellent in terms of patient friendly Job Type: Full-time Salary: \xe2\x82\xb925,000.00 - \xe2\x82\xb935,000.00 per month Ability to commute/relocate:

• Mumbai, Maharashtra: Reliably commute or planning to relocate before starting work (Required)

• Do you have any specialization in BDS/BAMS/BHMS/BUMS ?
• Do you have experience in claim processing - Hospitals / TPA ?

• Medical Advisor: 2 years (Required)