Medical Advisor

2 weeks ago

Mumbai, India Elevation HR LLP Full time

**JOB PURPOSE**

To assist clinical research teams and often help training and supporting the sales force. To provide an authoritative opinion regarding medical based questions, legal and regulatory matters thus enabling colleagues to comply with the required statutory requirements.

**PRINCIPAL ACCOUNTABILITIES**
- 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 the patients(Claim Document Submission).
- 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)

**QUALIFICATIONS AND SKILLS**
- Must have experience of 2-5 years
- BDS in Any Specialization, BAMS in Any Specialization, BHMS in Any Specialization, B.U.M.S in Any Specialization
- 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, clinical practices and protocol
- Excellent in terms of patient friendly

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

Ability to commute/relocate:

- Mumbai, Maharashtra: Reliably commute or planning to relocate before starting work (required)

Application Question(s):

- Do you have any specialization in BDS/BAMS/BHMS/BUMS ?
- Do you have experience in claim processing - Hospitals / TPA ?

**Experience**:

- Medical Advisor: 2 years (required)

**Speak with the employer**
+91 9311074203

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