05/09 Puja

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AXA Business Services - Doctor - MBBS (5-10 yrs) Premium

Bangalore Job Code: 4344

Job Description:-

Full time doctor (1 role)

- Resource should be an MBBS graduate with sound clinical knowledge to support the team of paramedics. Ability to identify medical necessity in the treatment planned and rendered by provider

- Must have 5+ years of clinical experience with health insurance claims knowledge

- Health insurance is a mandatory requirement

- Certifications in medical coding from AAPC or AHIMA (CPC, CIC, COC, CCS,etc)

- Involved in analyzing medical reports to assist in adjudicating Health insurance claims - Pre-authorization and Claims assessment.

- Play a strategic role in enhancing end customer experience by proactively communicating with onshore stakeholders to bring about improvement in performance of program

- Drive high quality execution and operational excellence.

- Identify causes of performance deficiencies and determine appropriate follow up actions

- o Review and implement Medical protocols for staff oversight and development

- Leverage Clinical acumen to provide guidance to staff

- Plan/implement/manage medical programs - E2E medical knowledge management

- Oversee ongoing monitoring and internal auditing as against relevant guidelines and standards

- Assist Staff in navigating the medical management system (disease state, health conditions)

- Develop/oversee technical trainings - Periodic knowledge assessments to identify and arrest leakage

- Support and formulate Internal medical Query Management with knowledge base creation

- Leverage tools or experience based learning methodologies to encourage accelerated learning and knowledge dissemination - Develop Training material for new joiners and refresher

- Build pool of specialists based on top medical conditions among existing paramedic staff

- Extensive experience in interactions with clients/onshore teams - Proactive engagements to review progress of improvement in the program

- Compliance with client/project guidelines, business rules and training provided company's quality system and policies.

- Communication / Issue escalation to seniors if there is any in a timely manner

- Keep self-up-to-date on latest developments in the domain with respect to products and services offered in Medical field.

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