Tpa Executive

2 weeks ago

Lucknow, India Nova Hospital Ltd Full time

Medical Scrutiny

Provide Medical opinion for Health Insurance Claims
Processing of Cashless Requests & Health Insurance Claim Documents
Proficient with medical terms & system.
- Actively responds to any query/additional information asked by the concerned TPA regarding the treatment of the patient.

Understanding of Policy terms & conditions & Various Protocols / Guidelines
Understanding of Claims adjudication / Claims Processing
Maintaining & Ensuring Standard Operating Procedures & Protocols
Ailment Wise ICD & Procedure Coding
Manage volumes effectively & efficiently to maintain Turnaround time of processing cases
VIP Claims Processing and TAT Maintenance
Claim Case Management / Cost Management

**Essential**:

- At least 3 yrs experience in Medical Officer Claims Processing Cashless.
- Good Excellent oral and written communication, negotiation and decision-making skills.
- Good customer service/relationship skills and ability to work effectively in a fast paced environment with shifting priorities.

Schedule:

- Fixed shift

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