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.
CANDIDATE PROFILE:
- Qualification must be BAMS, BHMS or BDS
- Only BAMS & BHMS freshers will be considered
- BDS candidates must have prior health claims processing experience
- Candidate must be comfortable with work shifts on roster basis & rotational week-off. .
02What you'll need
Experience
0 to 4 Yrs
Employment Type
Full time
Programming languages
health claimsadjudicationregulatory guidelinesmedical knowledgepolicy wordingsTATsquality reviewgrievance redressalfraudulent claims
