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