26/02 Bandana Padhi
Senior HR at Planet Solutions Consultancy

Views:3627 Applications:207 Rec. Actions:Recruiter Actions:127

Claim Processing Doctor - MBBS/BAMS/BHMS/BDS - Insurance (1-5 yrs)

Hyderabad Job Code: 5787

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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