Claim Quality Analyst

Qualification: MSC, B.Pharma, M.Pharma

Key Responsibilities:
Good communication skill.
Knowledge in computers like MS office.
Good medical knowledge.
Independently process Post hospitalization claims; process complex claims with minimal assistance
Needs to validate the information on all medical claims received. Claims must be thoroughly reviewed and ensure that there is no missing or incomplete information
Suggest operational policies, workflows and process improvement initiatives
Proactive approach by informing Providers regarding missing or repetitive errors by various hospital departments and improvisation of the same.
Applying medical and surgical aspects to scrutinize the patient reports and other documents.
Application of medical knowledge to bifurcate the claims.
Analyzing and justifying the care and management given to the patient
Thorough understanding of medical terminology in relation to diagnosis and procedures and meeting daily targets.
Updating skills and medical knowledge with routine enhancement programs.
Adjudication of claims as per the office memorandum of the concern scheme protocols
Responsible for the accurate and timely processing of post discharge cashless claims.
Meets quantity and quality claims processing standards.
In-depth understanding of the hospitals processes, policies and procedures
Verify Medical, billing related documents for further claim processing.