Managing a team of Claims Executive and monitor the claims being processed
Giving the medical advice on all the claims being received
Acting as the final authority in approving/ rejecting the claims
Allocation of investigable claims to investigators along with triggers for investigation.
Assess quality of investigation basis findings and reports
Ensuring an error free scruitinisation of Claims raised by Insured and Hospitals in purview of approved standards for Ailment and Treatment, Patient billing covered under the medical insurance policy
Pre-Authorization to Empanelled Hospitals [CASHLESS].
Ensuring all Customer Queries are responded in defined time.
Intermittently Corporate and Hospitals visits & Hospitals investigations.
Supervising Med Claim Processing, Finalizing Claim amount Recommended by Team Doctors, reviewing and resolving Claims Problems and Appeals.
Interacting with and providing verbal and written responses to Providers, Patients, and Third Party Payers and Departmental personnel including Doctors Team.
Review daily staff processing of Cashless and Reimbursement Claims inclusive of Pre-authorization to Empanelled Hospitals, Reimbursement Claim filling and Settlement, Auditing, Grievances solving.
Reviewing and Analysis Fact and Figures on MIS.