Medical Officer-Claims (TPA Experienced)

Job description

Roles and Responsibilities

• Dealing with patients health care related documents.
• Ensuring error free processing of pre authorisation within agreed TAT (Turnaround time).
• Entering accurate information into the application defined by the organization.
• Review structured clinical data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures defined by the insurer and the organization.
• Inform providers as needed and file completed pre certification requests as per procedures.
• Any authorization not as per the limit or as per the process to be escalated to the team manager on priority.
• Any medical opinion required from the specialist to be escalated to the specialist.
• Ensuring process compliance is met as per regulatory procedures.
• Maintaining Daily excel maintenance for Pre auth cases received and processed

Please contact MR Tanay Srivastava HR 'mobile no' Given below.

TTK Healthcare Services is a part of the 74 year old TTK Group providing TPA services to leading general insurance companies. TTK as a TPA provides call center, customer-relations and claim settlement services to the policy holders.