Medical Officer/Sr. 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).

Preferred candidate profile

• Good Excellent oral and written communication, negotiation, and decision-making skills.
• Good customer service/relationship skills and ability to work effectively in a fast-paced environment with shifting priorities .

Must be willing to work in non - clinic

TPA EXPERIENCE mandatory.

Clinical Exp.