Medical/Senior Medical Officer - Non Clinical

Roles and Responsibilities:

• 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.

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• Handing client calls both international and domestic .

Shifts: Rotational shifts (includes 10days of Night shift)

Interested candidates can share their resumes to disha.raman@mediassist.in or Whatsapp on 8904968911