Medical Officer

Karthika Consulting & Solutions; Bengaluru; On-site; INR 250,000 - 400,000; Full time

Job summary

Karthika Consulting & Solutions is seeking an Insurance Claims Processor in Bengaluru. You will act as the intermediary between hospitals and insurers, adjudicate cashless and reimbursement claims, and ensure accurate tabulation of payable vs non-payable items per policy.

Responsibilities include monitoring billing as per tariff, handling hospital escalations, and updating CRM with claim remarks. The role requires 0-3 years of relevant experience and strong analytical and communication skills.

Qualifications

• Must possess strong analytical thinking and ability to interpret policy documents.
• Excellent interpersonal and communication abilities, with a customer-service orientation.
• Willingness to learn and adapt to evolving health insurance rules and processes.

Responsibilities

• Serve as an interim liaison between insurance companies and hospitals.
• Adjudicate cashless and reimbursement claims with documents from the help desk.
• Perform claim tabulation to separate payable and non-payable items as per policy terms.

Skills

Analytical skills

Interpersonal & communication

Education

BAMS / BHMS / BDS / Bsc / MSc / Nursing / Dpharm / Bpharm

Job description

Job Duties & Responsibilities

• Play as an intermediate role Between the Insurance co. and Hospital and We Assist Team.
• Adjudicating cashless and Reimbursement claims with claim documents provided by help desk executive.
• Should be able to do claim tabulation to bifurcate payable and non-payable items as per the terms and conditions laid out in the insurance policy.
• Evaluating claims and posting remarks in whats app group and updating in CRM.
• Monitoring billing as per the Tariff.
• Managing claims escalations from hospitals.
• Responsible to handling queries raised by insurance company / TPAs
• Provide technical assistance and conduct training sessions for new processors on various health insurance policies.
• Evaluate complete claim documents before submission.
• Final Approval of Tabulation done by the team
• Coordinate with the Internal team to understand patient enquiries.
• Helping team to understand the Non-medical Items.
• Periodically educating the claim assistance department about the changes in the policy, rules & regulations and application deduction on settlement.
• To create awareness about reimbursement claims. (Pre, Post & Hospitalization) and communicating the important updates to the Claims Assistance and Finance Department
• Be available at the office for supporting onsite staff on all six days in a week b/w 9.30am to 7.00pm
• Efficiently and effectively handle grievance / issue raised by hospital staff & patients, elevate issue to the team leader, Manager Insurance Adjudication and Business Head as necessary.
• Follow-up on the updates to be given to the clients / onsite team of Claims Assistance Department

Qualifications & Skills.

• BAMS / BHMS / BDS / Bsc / MSc / Nursing / Dpharm / Bpharm
• 0 -3 years of relevant experience
• Should have good analytical skills
• Excellent interpersonal & communication skills

Experience.

• 0-3 years of experience in TPA or Indian Insurance claims or similar field or fresher

Additional Skills.

• Strong verbal skills Fluency
• Strong problem-solving skills and enthusiasm for new tasks and challenges
• Relationship building skills.
• Ability to multitask and prioritize, with a strong work ethic and attention to detail
• Ability to operate with a high level of confidentiality and professionalism
• A willingness to accept a high degree of uncertainty, jump in and help wherever needed, get hands dirty, and wear multiple hats on a fast-moving team.
• Should be able to manage the task assigned, while managing the tasks of the team/ team members that are assigned
• Should have an ability to manage and maintain smooth relationship with cross functional department such as Finance, Claims Assistance, Back-Office and Marketing Team