Medical Doctor

Roles and responsibilities:

Medical Doctor

• Processing of health claims as per SOP/guidelines shared,

• Day to day achievement of expected productivity with out compromising on the quality parameters.

• Identification of Fraud triggers and possible leakage

• Complete understanding of health claims processing • Aware of latest regulations and its implications

• Adherence to the prescribed TATs for each category

• Thorough medical knowledge, clinical efficacy of the treatment protocols given

• Able to read, interpret and question the information on the medication and relation to the diagnosis

• Clear understanding on ICD code and procedure codes

• Case management where there is possibility of inflation/abuse

• Interpretation of the product wordings for appropriate claims decision