Medical Officer

Family Health Plan (FHPL); Chennai District; On-site; INR 350,000 - 520,000; Full time

Job summary

Family Health Plan (FHPL) in Chennai is seeking a Claims Analyst to scrutinize claims as per the checklist and coordinate with the CRM team to obtain benefit plans for corporate clients, ensuring documentation and adherence.

The role requires coordinating with the CRM team, providing triggers to the investigation team for CDRF and surveyor cases, resolving critical issues, and applying final authority on claim status.

Qualifications

• BAMS/BUMS/BHMS with registration are preferred.
• Experience in Third Party Administration (TPA) is desirable.

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 and TPA experience

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.