Medical Officer

2 months ago

Delhi Delhi, India Safeway Insurance TPA Pvt. Ltd Full time

**CLAIM PROCESSING-**

1.Medical Scrutiny by thorough assessment of documents.
2.Provide Medical opinion on admissibility of Insurance Claims.
3.Proficient with medical terms & system.
4.Understanding of Policy terms & conditions with their practical applicability & Various Protocols / Guidelines.
5.Understanding of Claims adjudication / Claims Processing with a learning & progressive approach.
6.Ailment Wise ICD & Procedure Coding & mentioning the correct medical terminology while processing claims.
7.Manage volumes effectively & efficiently to maintain Turnaround time of processing cases.
8.Assess the eligibility of medical claims and determine financial outcomes.
9.Identification of trigger factors of insurance related frauds and inform the concerned department.
10.Determine accuracy of medical documents.
11.Daily reporting to HOD & processing all assigned claims within TAT.
12.Keeping a regular check on the assigned claim.
13.Disciplined & Regular working attitude.
14.Proper Coordination with support staff while processing claims.
15. Updating the new medical terms & conditions as per the policy.
16. Queries to be raised in 1 go with optimum quality.

**Language** - English & Bengali

**Education - UG**: Graduate : BDS, BHMS, BUMS, BPT

**Job Types**: Full-time, Permanent

Pay: ₹20,000.00 - ₹35,000.00 per month

**Benefits**:

- Health insurance
- Provident Fund

Schedule:

- Day shift

Ability to commute/relocate:

- New Delhi, Delhi: Reliably commute or planning to relocate before starting work (preferred)

**Experience**:

- Health TPA: 1 year (preferred)

**Language**:

- Bengali (required)

Work Location: In person

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