Check the medical admissibility of a claim by confirming the diagnosis and treatment details.
Scrutinize the claims, as per the terms and conditions of the insurance policy.
Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc.
Understand the process difference between PA and an RI claim and verify the necessary details accordingly.
Verify the required documents for processing claims and raise an IR in case of an insufficiency.
Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff.
Approve or deny the claims as per the terms and conditions within the TAT.
Handle escalations and responding to mails
accordingly.
Handing client calls both international and domestic .
Shifts: Rotational shifts (includes 10days of Night shift)
Qualification: BAMS , BDS, BHMS .
Mode of interview: Face to face .
Preferably Looking for male candidates , with clinical experience or TPA experience .
Job Type: Full-time
Pay: ₹300,000.00 - ₹400,000.00 per year
Benefits:
Health insurance
Paid sick time
Provident Fund
Application Question(s):
will you be able to join us within in 7 days
Current Location
Do you have a bachelor's degree in BAMS/BHMS/BDS
Total Experience
Current CTC
Expected CTC
Work Location: In person
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