Walk-in || Claim Adjudicator

Job Duties & Responsibilities

• Play as an intermediate role Between the Insurance co. and Hospital andWe AssistTeam.
• Adjudicatingcashless and Reimbursement claims with claim documents provided by help desk executive.
• Should be able to do claim tabulation to bifurcate payable and non-payable items as per the terms and conditions laid out in the insurance policy.
• Evaluating claims and posting remarks inwhatsapp group and updating in CRM.
• Monitoring billing as per the Tariff.
• Managingclaimsescalations from hospitals.
• Responsibletohandlingqueriesraised by insurance company / TPAs
• Provide technicalassistanceand conduct training sessions for new processors on various health insurance policies.
• Evaluate complete claim documents before submission.
• Final Approval of Tabulation done by the team
• Coordinate withthe Internalteam to understand patient enquiries.
• Helping team to understand the Non-medical Items.
• Periodically educatingthe claimassistancedepartmentaboutthe changes in the policy, rules ®ulationsand applicationdeduction on settlement.
• To create awareness about reimbursement claims. (Pre, Post & Hospitalization)and communicating the important updates to the Claims Assistance and Finance Department
• Be available at theoffice for supporting onsite staffon allsix days in a week b/w 9.30am to7.00pm
• Efficiently and effectively handle grievance / issue raised by hospital staff & patients, escalateissueto theteam leader,Manager Insurance Adjudicationand BusinessHeadas necessary.
• Follow-upon the updates to be given to the clients/ onsite team of Claims Assistance Department

Qualifications & Skills 

• BAMS / BHMS/ BDS /Bsc/ MSc / Nursing/Dpharm/Bpharm
• 0 -2yearsofrelevantexperience
• Should have good analytical skills
• Excellent interpersonal & communication skills

Experience 

0-2years of experience inTPAorIndianInsuranceclaimsor similar fieldor fresher

Additional Skills 

• Strong verbal skills Fluency
• Strong problem-solving skills and enthusiasm for new tasks and challenges
• Relationship building skills.
• Ability to multitask and prioritize, with a strong work ethic and attention to detail
• Ability tooperatewitha high levelof confidentiality and professionalism
• A willingness to accept a high degree of uncertainty, jump in and help wherever needed, get hands dirty, and wear multiple hats on a fast-moving team.
• Should be able to manage the task assigned, while managing the tasks of the team/ team members that are assigned
• Should haveanability to manage andmaintainsmoothrelationshipwith cross functionaldepartmentsuch as Finance, Claims Assistance, Back-Officeand Marketing Team