Senior Medical Officer
2 weeks ago
Designation: Senior Medical Officer
Function: Claims PA/RI Approver
Reporting to: Assistant Manager/Manager
Location: Andheri East, Mumbai
Educational Qualification: BAMS, BHMS, BPT, MBBS, BSc. Nursing
Additional Qualification: None
Specialization: General Medicine
Related courses attended: None
Management Level: Junior Management Level
Industry Type: Hospital/TPA/Healthcare/Insurance
Roles and Responsibilities :
- Check the medical admissibility of a High Value claim, scrutinize and process it as per terms & conditions of insurance policy.
- Handle escalations, customer queries and responding to mails accordingly
- Effectively manage the team so that the targets are met while reducing the no. of IRs raised.
- Ensure that the claims are approved or denied as per the terms and conditions within the TAT.
- Provide supportive and positive experience to the new joiners and train them.
- Gather inputs from various sources and keep up-to-date on the new policies or changes in
- existing policies and intimate the Configuration team and the CRM team
- Manage a group of claim processors, guide and coach them to meet their targets.
Key Results and Outcomes driven by this role:
- Zero penalty from insurers
- Error-free processing (100% Accuracy)
- Maintaining TAT
- Productivity (Achieve the daily targets)
Relevant Experience: 3 - 4 years
No of years of experience: 5-6 years
Demonstrated abilities, if any: None
Technical Competencies
- Analytical Skills
- Basic Computer knowledge
- Type writing skills
- Process and Domain Knowledge
Behavioral competencies
- Flexibility
- Time Management
- People Management
- Communication skills
- Decision Making
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