Medical Officer(Claims)

Medi Assist; Mumbai; On-site; INR 420,000 - 650,000; Full time

Job summary

Medi Assist in Mumbai is seeking a Claims Analyst to check medical admissibility, verify diagnosis and treatment details, and scrutinize claims as per policy terms.

You will interpret ICD codes, evaluate co-pay and room tariffs, and determine eligibility within the required TAT, coordinating with LCM and provider teams as needed.

This on-site role at our Mumbai office offers opportunities to contribute to cost containment and improved customer service in health benefits administration.

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.

Job description

About Us:

Medi Assist is India's leading Health Tech and Insure Tech company focused on

administering health benefits across employers, retail members, and public

health schemes. We consistently strive to drive innovation and participate in

such initiatives, to lower health care costs.

Our Health Benefits:

Administration model is designed to deliver the tools necessary for a health

plan to succeed, whether its our modular claims management system, our

technology that unveils data to make important decisions, or our service

solutions built around the voice of the customer. In short, our goal is to link

our success to that of our members

Roles and 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.

Work from Office only

Mumbai address: 4th floor, AARPEE Chambers, Off Andheri-Kurla Road Industrail Estate Marol, Andheri East, , Marol Cooperative Next To Times Square, Shagbaug, Gamdevi, Marol, Mumbai, Maharashtra 400059