Walk-in | Medical Officer

Authentic HealthCare; Dadri; On-site; INR 260,000 - 420,000; Full time

Job summary

Authentic HealthCare is hiring for a claims processing role focused on medical claim adjudication. You will verify diagnoses, treatment details, ICD coding, and policy terms to determine admissibility.

Responsibility includes document verification, handling co-pays, room tariffs, and open billing vs packages, while meeting strict turnaround times and maintaining high accuracy and productivity.

Qualifications

• Computer knowledge mandatory and capable of accurate processing.
• Maintain turnaround time (TAT) and achieve daily targets.
• Ensure error-free processing and high accuracy.

Responsibilities

• Check the medical admissibility of a claim by confirming the diagnosis and treatment details.
• Scrutinize the claims per the terms and conditions of the insurance policy.
• Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, caps, and differentiation of open billing and package.
• Verify the required documents for processing claims and raise an IR in case of insufficiency.
• MOU deductions.
• Approve or deny the claims per the terms within the TAT.

Skills

Computer knowledge

Accuracy

Time 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.
• Verify the required documents for processing claims and raise an IR in case of an insufficiency.
• MOU deductions
• Approve or deny the claims as per the terms and conditions within the TAT.

Preferred candidate profile- Computer Knowledge mandatory

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