Insurance Manual Claim Adjudication
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Job Location:
Coimbatore - India
Monthly Salary:
Not Disclosed
Posted on:
9 hours ago
Vacancies:
1 Vacancy
Job Summary
Job Description:
- Verify medical codes diagnosis and procedure to ensure compliance with industry standards (e.g. ICD 9 ICD 10 CPT)
- Review Clinical & Day Case claims and approve/reject basis the SOP.
- Review Hospital Inpatient & Outpatient Claims analyze the vouchers/medical documents categorize the benefits as per the SOP and approve/reject basis the SOP.
- Provide guidance and support to facilitate junior advisors resolve complex claims.
- Identify potential fraud waste and abuse (FWA) Flag suspicious cases highlight patterns and work with compliance teams to ensure early detection and escalation.
Points to be noted:
- Candidates qualification should be from a science background.
- Manual Claims Adjudication Knowledge should be able to speak on the topic.
- Verify medical codes diagnosis and procedure to ensure compliance with industry standards (e.g. ICD 9 ICD 10 CPT)
- Review Hospital Inpatient & Outpatient Claims.
- Knowledge about Human Anatomy
