Medical Officer

Family Health Plan (FHPL); Ahmedabad District; On-site; INR 250,000 - 380,000; Full time

Job summary

Family Health Plan (FHPL) in Ahmedabad seeks a claims investigator to scrutinize claims and coordinate with the CRM team to obtain and document benefit plans. The role involves communicating with investigators and triggering the investigation process for CDRF and surveyor cases.

You will assist the CRM team in resolving critical issues and prioritizing settlements, ultimately applying final authority to determine claim status. Registered TPA experience is preferred.

Qualifications

• Registration and relevant experience into TPA is preferred.

Responsibilities

• To scrutinize the claims as per the checklist.
• Co-ordinate with CRM team for obtaining benefit plans of corporate and ensure that the same is documented and followed.
• Correspond and communicate to the investigator by giving triggers to the investigation team regarding CDRF and surveyor cases.
• Coordinate with CRM team and help them in sorting out critical issues and in settlement of priority claims.
• Final authority to decide on the status of claim.

Education

BAMS/BUMS/BHMS with registration

Job description

Role & responsibilities

• To scrutinize the claims as per the checklist.
• Co-ordinate with CRM team for obtaining benefit plans of corporate and ensure that the same is documented and followed.
• Correspond and communicate to the investigator by giving triggers to the investigation team regarding CDRF and surveyor cases.
• Coordinate with CRM team and help them in sorting out critical issues and in settlement of priority claims.
• Final authority to decide on the status of claim.

Preferred candidate profile

BAMS/BUMS/BHMS candidates with registration and relevant experience into TPA is preferred.