Quality Control ll Health Claims ll Hdfcergo ll WFO

Role & responsibilities

• Responsible for the basic adjudication checks in terms of the product and policy details in line with the claim lodged.
• Apart from the fundamental checks such as name, age/ sex, hospital, insured, claim amount and recommended approval amount, the QC team member shall also check if the entries in data/ documents as presented by the previous processing line (bill entry and medico processors) are in corroboration with the actual facts available in claim documentation.
• Ensure that there shall be no financial/ non-financial errors from a processing perspective thereby completing the loop as a checker in the maker/ checker cycle.
• Ensuring timely settlement of claims in line with the principle of customer satisfaction along with the due diligence of policy terms and conditions shall also be the core responsibilities of a QC team member

Preferred candidate profile

• 1-6 years of relevant work experience (preferably with the TPA/ health insurance adjudication background in Indian health insurance domain)
• Educational qualification preferably with a health science background/ auxiliary medical degree
• Better teamwork skills (team bonding and ability to work as a team)
• There would be coordination with other teams required; mailing skills etc