Job Description :
ï Evaluates and processes claims in accordance with insurance policy terms and conditions, company policies and procedures according to productivity and quality standards.
ï Ensures that targets are met for department Turnaround time, Quality and Productivity.
ï Identify and report back any type of claims observation or issues that may affect the process.
ï 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.
ï Analyze reports from the administrative software for provider and member utilization trends and identification of areas requiring further management.
ï Support the Team leader / Manager in implementation of quality assurance programs in order to maintain standards of quality and minimize fraudulent cases.
ï Handling medical related call queries.
ï Maintain confidentiality with regard to the information being processed, stored or accessed.
ï Completes other projects and duties as assigned.
Skills and qualification requirements :
ï Should be willing be to work shifts (morning, evening and night shifts)
ï Must be an MBBS Graduate
ï Candidates able to start immediately preferred
ï 2 years minimum clinical experience