Tpa Doctor/grievance Officer

14 hours ago

Pune Maharashtra, India Medicon Group Full time

**Urgent Requirement of TPA Doctor/Grievances Officer at Medicon Group**

**Location: Gurgaon Haryana**

**Experience: 1 - 3 Years (in TPA/Government Portal Claims Processing)**

**Responsibilities**:

- Review and process medical claims submitted by policyholders and healthcare providers.
- Verify claim details, including medical procedures, diagnosis, and coverage eligibility.
- Ensure adherence to established protocols and guidelines for claims processing
- Investigate and resolve any discrepancies or issues related to claim submissions.
- Handle customer inquiries, complaints, and grievances related to claims processing.
- Provide clear explanations of claim decisions to policyholders and healthcare providers.
- Collaborate with internal teams to address complex claims or medical cases requiring further review.
- Maintain accurate records of claim activities, grievances, and resolutions.
- Stay updated on relevant industry regulations and guidelines for claims processing
- Suggest improvements to streamline processes and enhance customer satisfaction

**Requirements**:

- Medical degree (from a recognized institution)
- Prior experience working in a TPA or insurance company is preferred.
- In-depth knowledge of medical terminology, procedures, and coding systems
- Familiarity with insurance policies, coverage terms, and claim filing procedures.
- Strong analytical skills with attention to detail for accurate claims review
- Excellent written and verbal communication skills for effective customer interactions
- Ability to empathize with customers while maintaining professionalism in challenging situations.
- Proficiency in using computer systems and software for claims processing.
- Strong organizational and time-management skills to meet deadlines and prioritize tasks.
- Ability to work independently and as part of a team in a fast-paced environment.

**Salary**: ₹25,000.00 - ₹35,000.00 per month

Schedule:

- Day shift

**Education**:

- Bachelor's (preferred)

**Experience**:

- TPA: 1 year (preferred)
- Claim Management: 1 year (preferred)

Work Location: In person

**Speak with the employer**
+91 09877869915

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