Claim Processing Doctor, Gachibowli, Hyderabad

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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.

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