- 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.
Job Type: Full-time
Pay: ₹340,000.00 - ₹450,000.00 per month
Benefits:
- Health insurance
- Paid sick time
- Paid time off
- Provident Fund
Application Question(s):
- How many years of experience do you have?
- What is your expected CTC in Lakhs per annum?
- Do you have a degree in BHMS / BAMS / BPT / BDS/ BUMS/ BSc. Nursing?
- What is your current CTC in Lakhs per annum?
Work Location: In person
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