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Health Claims Examiner
2 weeks ago
- Analyze medical records and reports to determine claim validity and accuracy.
- Ensure compliance with relevant regulations and standards in all medical information and claim processing.
- Determine claim legitimacy based on medical evidence and insurance policies.
- Collaborate with internal teams (claims, operations, sales) and external stakeholders (clients, medical professionals).
- Generate reports and documentation related to reviewed claims.
- Stay updated on medical advancements and regulatory changes to improve processes.
To excel in this position, you will need:
- Medical Knowledge: Strong understanding of medical terminology, anatomy, physiology, and common medical conditions.
- Critical Thinking: Ability to analyze data, identify inconsistencies, and make sound judgments.
- Communication: Effective verbal and written communication skills to interact with clients and colleagues.
- Attention to Detail: Meticulous approach to ensure accuracy and completeness in all work.
- Regulatory Compliance: Knowledge of relevant insurance regulations and standards.
- Problem-Solving: Ability to identify and resolve discrepancies or issues within claims.
Qualification Required: MBBS/BHMS/BAMS/BUMS/BDS (with TPA/Insurance Company/Brokers background and good medical knowledge)
Experience Required: 3-5 years in claims (cashless/reimbursement)
