Medical Reviewer

6 months ago

Pune Maharashtra, India Principal Global Services Full time

**Responsibilities**:
Review and summarize applicant's medical information such as Attending Physician Statements, lab reports, paramed exams, and/or other related underwriting information consistent with the company's standards. Provide clear file documentation to support the onshore underwriting. Consult available resources including technical documentation, updates, co-workers, and trainers to perform daily task and meet performance targets as per training plan.

Improve personal effectiveness that positively impacts work, environment, and enhancement of skills, develop partnerships among peers/HO those supported to increase ownership of work and sustain an efficient process. Perform other job-related duties, other processes within the BU or special projects as required or as assigned by superior. Works on multiple products effectively with required productivity & accuracy targets for each product.

Partner with HO Counter parts, Trainers, SMEs, and Associates for effective sharing of best practices, Handling extra responsibilities like reviews, performance tracking and team bonding events, Training and on floor support for queries resolution

Improve efficiencies by submitting Operational Excellence ideas

Qualifications:
Bachelor's / Master's degree in medicine preferred (MBBS, BAMS, BHMS etc.), Minimum of 2-3 years’ experience in back office, domain knowledge of Life and Health Insurance (Individual & Group Insurance), Typing test - 35-40 Wpm (Numeric), 99% accuracy, Good hands on knowledge of Excel, Excellent written and verbal communication skills, Insurance Domain knowledge (Domestic / Abroad - Health/ Life/ Disability /Dental claim processing experience Preferred), MS Office Proficient. Decision making skill, Problem solving, Good analytical skill. Domain knowledge of Life and Health Insurance (Individual & Group Insurance), Medical coding related certification and experience will be an addon.
- Bachelor’s degree or equivalent -16-17.5yrs of Formal Education from recognized and accredited University. Bachelor's / master’s degree in medicine would be preferred (MBBS, BAMS, BHMS, etc.).
- Minimum of 2-3 years’ experience in back office. Insurance -Domestic Insurers / abroad, experience in Claims processing of Health Insurance / Life and disability claims/ Underwriting experience preferred.
- Knowledge of ICD-10 & CPT coding with CPC certification will be an added advantage.
- Good MS Office, Good written and verbal communication skills.

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