Medical Officer

Job description

• Check the medical admissibility of a claim by confirming the diagnosis and treatment details.
• Scrutinize the claims as per the terms and conditions of the insurance policy
• Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiate open billing and package, etc.
• Understand the process difference between PA and an RI claim and verify the necessary details accordingly.
• Verify the required documents for processing claims and raise an IR in case of an insufficiency.
• Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff.
• Approve or deny the claims as per the terms and conditions within the TAT.
• Handle escalations and respond to emails accordingly.

Interested candidates can share their CV'S to sarika.pallap@mediassist.in or WhatsApp on 8951865563