Medical Officer

Family Health Plan (FHPL); Gurugram District; Vor Ort; INR 400.000 - 700.000; Vollzeit

Zusammenfassung

Family Health Plan (FHPL) in Gurugram is seeking a claims analyst to scrutinize claims, coordinate with the CRM team, and guide investigation triggers for CDRF and surveyor cases.

The role requires BAMS/BUMS/BHMS with registration and TPA experience, with emphasis on documenting benefit plans and prioritizing settlements. Final authority on claim status will be held by the candidate.

Qualifikationen

• BAMS/BUMS/BHMS degree with registration.
• Registration and experience in TPA preferred.

Aufgaben

• To scrutinize the claims as per the checklist.
• Coordinate 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.

Ausbildung

BAMS/BUMS/BHMS

Jobbeschreibung

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.