Medical Officer @ Medi Assist

Job Description

POSITION: MEDICAL OFFICER/CONSULTANT PA/RI APPROVER

PURPOSE OF ROLE:
To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge.

Designation : Medical Officer/Consultant
Function : Claims PA/RI Approver
Reporting to : Assistant Manager Claims
Location : Mumbai
Educational Qualification : BHMS, Bsc Nursing , BAMS, BPT, MBBS
Shift : Rotational Shift (for female employee shift ends at 8:30 PM)
Week offs : 6 rotational week offs Provided per month
Management Level : Junior Management Level
Industry Type : Hospital/TPA/Healthcare/Insurance

Roles and Responsibilities :

• 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, differentiation of 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 responding to mails accordingly.

Key Results and Outcomes driven by this role:

• Error-free processing (100% Accuracy)
• Maintaining TAT
• Productivity (Achieve the daily targets)

Relevant Experience : 0- 2 years
No of years of experience : 0-2 years

If interested, please share your CV on:

Mail: sa**********p@me*******t.in

Whatsapp: 8792840***

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Rs 0 - 50K PM Rs 50K - 1 LPA Rs 1.0 - 1.5 LPA Rs 1.5 - 2.0 LPA Rs 2.0 - 2.5 LPA Rs 2.5 - 3.0 LPA Rs 3.0 - 3.5 LPA Rs 3.5 - 4.0 LPA Rs 4.0 - 4.5 LPA Rs 4.5 - 5.0 LPA Rs 5 - 6 LPA Rs 6 - 7 LPA Rs 7 - 8 LPA Rs 8 - 9 LPA Rs 9 - 10 LPA Rs 10 - 12 LPA Rs 12 - 14 LPA Rs 14 - 16 LPA Rs 16 - 18 LPA Rs 18 - 20 LPA Rs 20 - 22 LPA Rs 22 - 24 LPA Rs 24 - 26 LPA Rs 26 - 28 LPA Rs 28 - 30 LPA Rs 30 - 32 LPA Rs 32 - 34 LPA Rs 34 - 36 LPA Rs 36 - 38 LPA Rs 38 - 40 LPA Rs 40 - 42 LPA Rs 42 - 44 LPA Rs 44 - 46 LPA Rs 46 - 48 LPA Rs 48 - 50 LPA Rs 50 - 75 LPA Rs 75 Lakh - 1C PA Rs 1 Crore+ PA

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Keyskills:   Bpt Nursing BHMS BAMS OPD Ayurveda TPA General Medicine Homeopathy Medicine Bds Mediclaim Pharmacy Investigation Medical Hospital