Job Description

ROLES AND RESPONSIBLTY-

Must have effective communication skills.

Candidate must have sound knowledge about claims hospitals and TPA.

Excellent diagnostic skills using clinical knowledge and x-rays.

Excellent knowledge about Insurance policy terms and conditions

Good knowledge about medical admissibility of claims

Good knowledge of clinical practices and protocols.

Excellent in terms of patient friendly.

Answering patient queries regarding status of claims

Answering queries regarding grievance requests raised by

patients or hospitals.

Scrutiny of files to determine if the claims do really qualify to be
reimbursed or to be settled.

To determine if the amount of the claims requested fits into SOC
(Schedule of Charges) or PPN criteria

To verify if all the investigation reports have been submitted along with the claims

To make sure that intimation is received from the patient depending upon the type of claim i.e. cashless or non cashless (Claims Intimation)

To verify if all the document submission has been completed in time by t he patients(Claim Document Submission).