Website ICICI Lombard
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.
