Medical Officer

Role & responsibilities

1. Keeping claim pending if any document is missing and need to keep pending twice.

2. Ensure compliance all mandatory documents.

3. Ensure Communicating with Network hospitals regarding pending cases

4. Monitor fraudulent activity/ practices of NWH.

5. Analysis and reporting claims data.

6. Ensure claims processing as per Adjudication guidelines.

7. Ensure Claims & Preauth process within TAT

8. Scrutinize preauth & claims sent by Empanelled hospitals

9. Respond to Hospital telephonic queries if needed.

10. Need to Co-Operate informed with regards to medical Queries & Hospital Grievances to SHASs (State Health Assurance Society).

11. Depending on the job requirement, you may be required or allotted tasks in various department