Medical Officer- Non Clinical

2 weeks ago

Andheri Mumbai Maharashtra, India MEDI ASSIST INSURANCE TPA PRIVATE LIMITED Full time

**Roles & Responsibilities**:

- **Claim Processing**: Verify the medical admissibility of a claim by confirming diagnosis and treatment details.
- **Claim Scrutiny**: Scrutinize claims according to the terms and conditions of the insurance policy.
- **Data Interpretation**: Interpret ICD coding, evaluate co-pay details, and classify non-medical expenses, room tariffs, and capping details. Differentiate between open billing and package deals.
- **Process Verification**: Understand the process difference between a PA and an RI claim, and verify necessary details accordingly.
- **Document Verification**: Verify all required documents for processing claims and raise an IR (Information Request) if documents are insufficient.
- **Team Coordination**: Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of a tariff.
- **Claim Approval**: Approve or deny claims as per the terms and conditions within the TAT (Turnaround Time).
- **WhatsApp**: 9632777628

Pay: ₹335,000.00 - ₹430,000.00 per year

**Benefits**:

- Health insurance
- Paid sick time
- Paid time off
- Provident Fund

Work Location: In person

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