Medical Officer

Family Health Plan (FHPL); Ernakulam, Thiruvananthapuram; On-site; INR 300,000 - 600,000; Full time

Job summary

Family Health Plan (FHPL) invites Ayurveda professionals to join our claims team in Ernakulam, Kerala. You will scrutinize claims against our checklist, coordinate with the CRM team for benefit plans, and guide investigators on CDRF and surveyor cases.

Ideal candidates hold BAMS/BUMS/BHMS with valid registration and experience in TPA or related claims processing. You will help settle priority claims and have final say on claim status, working on-site with cross-functional teams to ensure smooth

Qualifications

• Registration as Ayurvedic practitioner (BAMS/BUMS/BHMS).
• Experience in TPA or related claims processing 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

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.