Medical Officer

Role & responsibilities

• To give Claims & Cashless/preauthorization, and scrutiny Medical Reimbursement Claims, and to Process Claims
• Third Party Administration (Health) services (TPA)
• Claims and Preauthorization Processing
• HealthCare Assistance Services
• High Ratio Claims Management in coordination with Networking and Empanelment Department
• Monitoring the overall operations of Claims and Preauthorization.
• Responsible for ensuring efficient response at the level of Preauthorization to maintain TAT.
• Ensure adherence to processes and controls.
• Creating the process for claim processing (Cashless and Reimbursement).
• Co-ordination between Network Hospitals/Preauthorization/Claims.
• Ensuring a high-quality patient care at customized/optimized cost.
• Creating the process for claim processing (Cashless and Reimbursement). Role & responsibilities

Preferred candidate profile

BHMS, BAMS, BUMS Only.