Medical Officer

Job Duties & Responsibilities  

• Play as an intermediate role Between the Insurance co. and Hospital and We Assist Team. 
• Adjudicating cashless 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 in what’s app group and updating in CRM. 
• Monitoring billing as per the Tariff. 
• Managing claims escalations from hospitals. 
• Responsible to handling queries raised by insurance company / TPAs 
• Provide technical assistance and 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 with the Internal team to understand patient enquiries. 
• Helping team to understand the Non-medical Items. 
• Periodically educating the claim assistance department about the changes in the policy, rules & regulations and application deduction 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 the office for supporting onsite staff on all six days in a week b/w 9.30am to 7.00pm 
• Efficiently and effectively handle grievance / issue raised by hospital staff & patients, escalate issue to the team leader, Manager – Insurance Adjudication and Business Head as necessary. 
• Follow-up on 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 -2 years of relevant experience 
• Should have good analytical skills 
• Excellent interpersonal & communication skills 

Experience  

0-2 years of experience in TPA or Indian Insurance claims or similar field or fresher