Medical Advisor

5 days ago

Andheri Mumbai Maharashtra, India Tristar Management Services Pvt Ltd Full time

We have opening in **Raksha Health Insurance TPA Pvt Ltd for Medical Advisor in Andhri East Location.**

**Company Name** - Raksha Health Insurance TPA Pvt Ltd.

**Location** - Andheri East (Marol)

**Exeperience**:

- Freshers/ Dr. (Intern)

**Qualification** - MD/ MBBS/ Bsc

**Salary** - 25k to 40k

**Medical Advisor**:

- Must have effective communication skills.
- Excellent diagnostic skills using clinical knowledge and x-rays.
- Excellent knowledge about Insurance policy terms and conditions.
- Good knowledge about medical admissibility of claims.
- Good knowledge of clinical practices and protocols.
- Excellent in terms of patient friendly.
- Answering patient queries regarding status of claims.
- Answering queries regarding grievance requests raised by patients or hospitals.
- Scrutiny of files to determine if the claims do really qualify to be reimbursed or to be settled.
- To determine if the amount of the claims requested fits into SOC (Schedule of Charges) or PPN criteria
- To verify if all the investigation reports have been submitted along with the claims
- To make sure that intimation is received from the patient depending upon the type of claim i.e. cashless or non cashless (Claims Intimation)
- To verify if all the document submission has been completed in time by t he patients(Claim Document Submission).

Thanks & Regards,

Shraddha Raut

8591995476

Tristar Management Services Pvt Ltd.

**Salary**: ₹25,000.00 - ₹40,000.00 per month

Schedule:

- Day shift

**Education**:

- Doctorate (preferred)

**Experience**:

- Medical Advisor: 1 year (preferred)

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