Medical Officer

2 weeks ago

Bengaluru, Karnataka, India Karthika Consulting & Solutions Full time ₹ 9,00,000 - ₹ 12,00,000 per year

Role & responsibilities

  • Play as an intermediate role Between the Insurance co. and Hospital and We Assist Team.
  • Adjudicating cashless and Reimbursement claims with claim documents provided by help desk executive.
  • Should be able to do claim tabulation to bifurcate payable and non-payable items as per the terms and conditions laid out in the insurance policy.
  • Evaluating claims and posting remarks in whats app group and updating in CRM.
  • Monitoring billing as per the Tariff.
  • Managing claims escalations from hospitals.
  • Responsible to handling queries raised by insurance company / TPAs
  • Provide technical assistance and conduct training sessions for new processors on various health insurance policies.
  • Evaluate complete claim documents before submission.
  • Final Approval of Tabulation done by the team
  • Coordinate with Internal team to understand patient enquiries.
  • Helping team to understand the Non-medical Items.
  • Periodically educating claim assistance department about the changes in the policy, rules & regulations and application deduction on settlement.
  • To create awareness about reimbursement claims. (Pre, Post & Hospitalization) and communicating the important updates to the Claims Assistance and Finance Department
  • Be available at the office for supporting onsite staff on all six days in a week b/w 9.30am to 7.00pm
  • Efficiently and effectively handle grievance / issue raised by hospital staff & patients, escalate issue to the team leader, Manager Insurance Adjudication and Business Head as necessary.
  • Follow-up on the updates to be given to the clients / onsite team of Claims Assistance Department

Qualifications & Skills.

  • BAMS / BHMS / BDS / Bsc / MSc / Nursing / Dpharm / Bpharm
  • 5-8 years of relevant experience
  • Should have good analytical skills
  • Excellent interpersonal & communication skills

Experience.

  • 5-8 years of experience in TPA or Indian Insurance claims or similar field or fresher

Additional Skills.

  • Strong verbal skills Fluency
  • Strong problem-solving skills and enthusiasm for new tasks and challenges
  • Relationship building skills.
  • Ability to multitask and prioritize, with a strong work ethic and attention to detail
  • Ability to operate with a high level of confidentiality and professionalism
  • A willingness to accept a high degree of uncertainty, jump in and help wherever needed, get hands dirty, and wear multiple hats on a fast-moving team.
  • Should be able to manage the task assigned, while managing the tasks of the team/ team members that are assigned
  • Should have an ability to manage and maintain smooth relationship with cross functional department such as Finance, Claims Assistance, Back-Office and Marketing Team

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