Paramount health insurance TPA Pvt Ltd. jobs - Medical Officer

Job Description : Medical Officer
1) Processing of cashless claim request received from the hospital
2) Proper scrutiny of the medical documents received from the hospital/ patient and ask for relevant details to corroborate with the available diagnosis.
3) Review the treatment details/ medication regimen given during hospitalization and ask for justification from treating doctor if treatment protocol is not appropriate to the diagnosis
4) Collate the medical details with the applicable policy terms to arrive at the final decision of claims adjudication.
5) Refer cashless claims to the investigation department  if hospital bills are found to be inflated or unreasonable billing done with reference to the diagnosis.
6) Refer cashless claims to investigation department if there is suspicion of fraud.
7) Accurate deduction of expenses that are not relevant to the diagnosis.
8) Coordination with Provider department team for hospital bill and available tariff dispute.
8) Coordination with the insurance company for their approval to proceed with final adjudication.
9) Active participation in sharing thoughts with the department HOD to refine cashless operations.
10) Handling cashless claim grievance effectively.
Nature of Work : Full Time / Non Clinical Role
Job Location :Thane Wagle Estate & Andheri Marol Naka
Work Experience : 0 - 2 years into TPA Industry
Qualification : BAMS/BHMS
Salary Range : Depends of current CTC
If interested, kindly share your updated resume on further details, feel free to call