Medical Officer

Medical Officer / Consultant (Work From Office Only)

Location: Bangalore

Experience: 0 to 3 Years

Qualification: BAMS / BHMS / BSc Nursing and MBBS(With indian registration)

We are looking for Medical Officers to review and process health insurance claims by applying medical knowledge and policy guidelines. The role involves evaluating medical admissibility, scrutinizing claim documents, and ensuring timely and accurate claim decisions.

Key Responsibilities:

• Check the medical admissibility of a claim by confirming the diagnosis and treatment details.
• • Scrutinize the claims, as per the terms and conditions of the insurance policy •
• Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. •
• Understand the process difference between PA and an RI claim and verify the necessary details accordingly. •
• Verify the required documents for processing claims and raise an IR in case of an insufficiency. •
• Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff. •
• Approve or deny the claims as per the terms and conditions within the TAT. Role & responsibilities

Interested candidates can drop their CV's to [email removed] or whatsapp on [phone removed].