Claim Quality Analyst

5 hours ago

Bengaluru, Karnataka, India MedVerve Healthcare Pvt Ltd Full time

Qualification: B.Pharma

Key Responsibilities:

  • Good communication skill.
  • Knowledge in computers like MS office.
  • Good medical knowledge.
  • Independently process Post hospitalization claims; process complex claims with minimal assistance
  • Needs to validate the information on all medical claims received. Claims must be thoroughly reviewed and ensure that there is no missing or incomplete information
  • Suggest operational policies, workflows and process improvement initiatives
  • Proactive approach by informing Providers regarding missing or repetitive errors by various hospital departments and improvisation of the same.
  • Applying medical and surgical aspects to scrutinize the patient reports and other documents.
  • Application of medical knowledge to bifurcate the claims.
  • Analyzing and justifying the care and management given to the patient
  • Thorough understanding of medical terminology in relation to diagnosis and procedures and meeting daily targets.
  • Updating skills and medical knowledge with routine enhancement programs.
  • Adjudication of claims as per the office memorandum of the concern scheme protocols
  • Responsible for the accurate and timely processing of post discharge cashless claims.
  • Meets quantity and quality claims processing standards.
  • In-depth understanding of the hospitals processes, policies and procedures
  • Verify Medical, billing related documents for further claim processing.

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