Senior HR at Planet Solutions Consultancy
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Claim Processing Doctor - MBBS/BAMS/BHMS/BDS - Insurance (1-5 yrs)
Job Description :
Company : ICICI Lombard
Position : Claim Process Doctor
Location : Gachibowli, Hyderabad
Exp : Min 1 yr
Qualification : BHMS, BAMS, MBBS
CTC : UP to 6.5 L/A
Duty Timing : 9 hours (Rotational between 9 AM to 8 PM) - No night Shift.
- Claims management processes e.g. authorization, adjudication, verification, audit etc.
- Evaluation of Treatment & Associated Costs
- Evaluation of Health Claims Ratio
- Interaction with Health Care Provider
- Coordination with internal & external teams
- Implement new process to cut down on cost and improve client service
Have to handle Critical Illness Claims, Team Management, Report Generations, Analytics, Process Management & Innovation, Maintaining and setting industry benchmarks, Project identification and implementation.
- Processing Mediclaims in Cashless. & Authorization.
- Issuing RAL/DAL/Queries/ADR during processing of media claims.
- Knowledge of ICD .
- Scrutiny, verification and cross-checking of medical claims so that only liable claims can proceed.
- In person visits to the hospitals concerned for checking the reality status of the claims.
- Coordination with the medical faculty in the final approval of the claim & Query resolving regarding media claims.
- Maintaining TAT of the claim processing.
- Handling the grievance call of the claimants & Hospitals & delivering technical answers.
- Quality check of Medical Reports & Bills submitted for processing.
- Rating the Empanelled Hospital as per their Merits.
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