Medical Officer- Non clinical
2 weeks ago
Roles & Responsibilities:
- Claim Processing: Verify the medical admissibility of a claim by confirming diagnosis and treatment details.
- Claim Scrutiny: Scrutinize claims according to the terms and conditions of the insurance policy.
- Data Interpretation: Interpret ICD coding, evaluate co-pay details, and classify non-medical expenses, room tariffs, and capping details. Differentiate between open billing and package deals.
- Process Verification: Understand the process difference between a PA and an RI claim, and verify necessary details accordingly.
- Document Verification: Verify all required documents for processing claims and raise an IR (Information Request) if documents are insufficient.
- Team Coordination: Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of a tariff.
- Claim Approval: Approve or deny claims as per the terms and conditions within the TAT (Turnaround Time).
- Communication: Handle escalations and respond to emails promptly.
Interested candidates can share their resumes via email or WhatsApp:
- Email:
- WhatsApp:
Job Type: Full-time
Pay: ₹335, ₹430,000.00 per year
Benefits:
- Health insurance
- Paid sick time
- Paid time off
- Provident Fund
Work Location: In person
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