Processing of health claims as per SOP/guidelines shared,
Day to day achievement of expected productivity with out compromising on the
quality parameters.
Identification of Fraud triggers and possible leakage
Complete understanding of health claims processing
Aware of latest regulations and its implications
Adherence to the prescribed TATs for each category
Thorough medical knowledge, clinical efficacy of the treatment protocols given
Able to read, interpret and question the information on the medication and
relation to the diagnosis
Clear understanding on ICD code and procedure codes
Case management where there is possibility of inflation/abuse
Interpretation of the product wordings for appropriate claims decisio
Job Classification
Industry: InsuranceFunctional Area / Department: BFSI, Investments & TradingRole Category: General InsuranceRole: Claims ManagerEmployement Type: Full time