Medical Officer - Non Clinical @ 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
Function
Medical Officer/Consultant
Claims PA/RI Approver
Reporting to
Location
Assistant Manager Claims
Chennai
Educational
Qualification
Shift
BHMS, , BAMS , BDS, B.Sc Nursing.
Rotational Shift (for female employee shift ends at 7:30
PM)
6 rotational week offs Provided per month
Week offs
Related courses
attended
None
Management Level
Junior Management Level
Industry Type
Hospital/TPA/Healthcare/Insurance
Roles and
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.



Responsibilities
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.




Error-free processing (100% Accuracy)
Maintaining TAT
Productivity (Achieve the daily targets)
Key Results and Outcomes
driven by this role:
0- 5 years
Relevant Experience
No of years of experience
0-5 years
None
Demonstrated abilities if
any
Technical Competencies

Analytical Skills


Basic Computer knowledge
Type writing skills


Communication skills
Decision Making
Behavioral competencies

Job Classification

Contact Details:

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0 - 1 Yrs 1 - 2 Yrs 2 - 3 Yrs 3 - 4 Yrs 4 - 5 Yrs 5 - 6 Yrs 6 - 7 Yrs 7 - 8 Yrs 8 - 9 Yrs 9 - 10 Yrs 10 - 11 Yrs 11 - 12 Yrs 12 - 13 Yrs 13 - 14 Yrs 14 - 15 Yrs 15 - 16 Yrs 16 - 17 Yrs 17 - 18 Yrs 18 - 19 Yrs 19 - 20 Yrs 20 - 21 Yrs 21 - 22 Yrs 22 - 23 Yrs 23 - 24 Yrs 24 - 25 Yrs 25 - 26 Yrs 26 - 27 Yrs 27 - 28 Yrs 28 - 29 Yrs 29 - 30 Yrs 30+ Yrs

Expected Salary (*)

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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Accounting / Finance Advertising / MR / PR / Events Agriculture / Dairy Animation / Multimedia Architecture / Interior Design Astrology Automobile / Auto Ancillaries / Auto Components Aviation / Airline / Aerospace / Aeronautical Banking / Financial Services / Broking BPO / Call Center / ITeS Brewery / Distillery Broadcasting Cement / Building Material Chemical / Petro / Plastic / Rubber / Glass Consumer Electronics / Appliances / Durables Courier / Transportation / Freight Defence / Government Education / Teaching / Training Electricals / Switchgears Engineering / Construction / Cement / Metals Environment / Waste Management Export / Import / Trading Facility Management Fertilizers / Pesticides FMCG / Foods / Beverage Food Processing Furnishings / Ceramics / Sanitaryware / Electricals Gems / Jewellery Gifts / Toys / Stationary Government / Departmental Heat Ventilation / Air Conditioning Hotel / Restaurant Industrial Design Industrial Products / Heavy Machinery Insurance Internet / E-Commerce IT - Hardware / Networking IT - Software / Services KPO / Research / Analytics Leather / Leather Products Legal / Courts Logistics / Courier / Transportation Management Consulting / Strategy Manufacturing / Production Matrimony / Matchmaking Media / Entertainment Medical / Healthcare / Hospital Merchant Navy Metal / Iron / Steel MFI - Micro Finance Military / Police / Arms Ammunition Mining / Quarrying NBFC-Non Banking Financial Services NGO / Social Work Office Equipment / Automation Not Mentioned Paint / Art / Sculpture / Craft Paper / Wood Personal Care / Beauty Pharma / Biotech / Clinical Research Politics Power / Energy / Oil / Gas / Petroleum Printing / Publishing / Packaging Quality Certification Real Estate / Property Recruitment Services / RPO Religion / Spirituality Retail Security / Detective Services Semiconductors / Electronics Shipping / Marine Telecom / ISP Textile / Garments / Fashion Travel / Tourism / Hotels / Airlines / Railways Unskilled Labor / Domestic Help Veterinary Science / Pet Care Sports / Fitness / Beauty NBFC ( Non Banking Financial Services ) Manufacturing Travel / Tourism Medical / Healthcare FMCG / F/B Education / Training IT Services / Consulting Software Product BPO / Call Center BFSI Power / Energy Recruitment Services Pharma / Biotech Oil / Gas / Petroleum Banking Real Estate Financial Services Accounting / Auditing Square 1 Consulting Services Hiring For A reputed Chemical industry Consumer Durables / Electronics Media / Dotcom / Entertainment Engineering / Construction Investment Banking / Venture Capital / Private Equity Aviation / Airline Automation Export-Import / Trading Shipping Hospitality FinTech Automobile / Auto Ancillaries Others Printing / Packaging Broking Auto Components E-Learning Furnishings / Sanitaryware / Electricals Chemical / Plastic / Rubber / Glass 97 KPO / Analytics Sanskar HR Consultancy Services Hiring For Chemical Industry Emerging Technologies MFI ( Micro Finance ) Heat ventilation Air conditioning Heat ventilation Air conditioning Subhadra Jobs Consultancy Hiring For Bpo Industry Subhadra Jobs Consultancy Hiring For Bpo Industry Acme Services Private Limited Hiring For Beauty Skin Care Industry Semiconductors Semiconductors Mining Sanskar HR Consultancy Services Hiring For Manufacturing Industry Sports / Fitness AMOHA CONSULTING AND VENTURES PRIVATE LIMITED Hiring For Urgent | Hiring for Branch Sales Manager role in NBFC Industry for Navi Mumbai - 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Keyskills:   Health Claims Insurance Claims Claims Management TPA Claim Settlement Claim Investigation Claims Adjudication Claims Processing