Medical Officer - Bangalore

Medi Assist; Karnataka; On-site; INR 280,000 - 360,000; Full time

Job summary

Medi Assist is seeking a detail-oriented claims verifier in India to check medical admissibility, confirm diagnoses and treatment details, and scrutinize claims per policy terms. You will interpret ICD codes, assess co-pays, and classify expenses while differentiating pa and RI processes.

Role emphasizes 100% accuracy, strict TAT adherence, and consistent daily productivity. Excellent organization and timely escalation handling are required for success.

Qualifications

• Role requires accurate processing of claims with high accuracy.
• Adheres to turnaround time (TAT).
• Meets daily targets for productivity.

Responsibilities

• Check the medical admissibility of a claim by confirming the diagnosis and treatment details.
• Scrutinize the claims, as per the terms and conditions of the insurance policy
• Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc.
• Understand the process difference between PA and an RI claim and verify the necessary details accordingly.
• Verify the required documents for processing claims and raise an IR in case of an insufficiency.
• Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff.
• Approve or deny the claims as per the terms and conditions within the TAT.
• Handle escalations and responding to mails accordingly

Skills

Accuracy

TAT management

Productivity

Job description

Role & responsibilities

• Check the medical admissibility of a claim by confirming the diagnosis and treatment details.
• Scrutinize the claims, as per the terms and conditions of the insurance policy
• Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc.
• Understand the process difference between PA and an RI claim and verify the necessary details accordingly.
• Verify the required documents for processing claims and raise an IR in case of an insufficiency.
• Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff.
• Approve or deny the claims as per the terms and conditions within the TAT.
• Handle escalations and responding to mails accordingly

Preferred candidate profile

• Error-free processing (100% Accuracy)
• Maintaining TAT
• Productivity (Achieve the daily targets)