• Evaluates and processes claims in accordance with insurance policy terms and conditions, company policies and procedures according to productivity and quality standards.
• Ensures that targets are met for department Turnaround time, Quality and Productivity.
• Identify and report back any type of claims observation or issues that may affect the process.
• Collect and analyze claims data to identify and resolve errors, delayed claims, and processing issues. Providing recommendations to take steps to improve the claims processing quality standards and productivity.
• Analyze reports from the administrative software for provider and member utilization trends and identification of areas requiring further management.
• Support the Team leader / Manager in implementation of quality assurance programs in order to maintain standards of quality and minimize fraudulent cases.
• Handling medical related call queries.
Skills and qualification requirements:
• Should be willing be to work shifts (morning, evening and night shifts)
• Must be an MBBS Graduate
• Candidates able to start immediately preferred
• Medical license not required
• 2 years minimum clinical experience
Candidates who match the above criteria can also forward CVs to [HIDDEN TEXT]are with the subject line 'Medical Claims Officer - OBO'. Emails received without the subject line will not be considered.