JOB RESPONSIBILITIES:
Applying medical knowledge in evaluating the medical claim files to ascertain the medical admissibility.
Must understand the policy wordings including Terms && conditions to adjudicate the
Admissibility/Rejection.
Processing of claims as per regulatory guidelines.
Adhering to the TATs in processing.
Quality review of processed files.
Grievance redressal, handling escalations and identifying the fraudulent claims.

Keyskills: claim processing health claim medical