Claim Specialist (TPA Insurance) Job

Key responsibilities:

1. Work on medical scrutiny
2. Provide medical opinion for health insurance claims
3. Process cashless requests and health insurance claim documents
4. Be proficient with medical terms and systems
5. Understand policy terms and conditions and various protocols/guidelines
6. Understand claims adjudication/claims processing
7. Maintain and ensure standard operating procedures and protocols
8. Work on ailment-wise ICD and procedure coding
9. Manage volumes effectively and efficiently to maintain the turnaround time of processing cases
10. Work on VIP claims processing and TAT maintenance
11. Work on claim case management/cost management

Requirements:

1. At least 2-3 yrs experience in medical officer claims processing cashless/reimbursement cases in any hospital
2. Good excellent oral and written communication, negotiation, and decision-making skills
3. Good customer service/relationship skills and ability to work effectively in a fast-paced environment with shifting priorities

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