Senior Medical Officer

2 weeks ago

Mumbai, Maharashtra, India Medi Assist Full time ₹ 2,50,000 - ₹ 7,50,000 per year

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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