Claim Quality Analyst

Qualification: B.Pharma

Key Responsibilities:

• Good communication skill.
• Knowledge in computers like MS office.
• Good medical knowledge.
• Independently process Post hospitalization claims; process complex claims with minimal assistance
• Needs to validate the information on all medical claims received. Claims must be thoroughly reviewed and ensure that there is no missing or incomplete information
• Suggest operational policies, workflows and process improvement initiatives
• Proactive approach by informing Providers regarding missing or repetitive errors by various hospital departments and improvisation of the same.
• Applying medical and surgical aspects to scrutinize the patient reports and other documents.
• Application of medical knowledge to bifurcate the claims.
• Analyzing and justifying the care and management given to the patient
• Thorough understanding of medical terminology in relation to diagnosis and procedures and meeting daily targets.
• Updating skills and medical knowledge with routine enhancement programs.
• Adjudication of claims as per the office memorandum of the concern scheme protocols
• Responsible for the accurate and timely processing of post discharge cashless claims.
• Meets quantity and quality claims processing standards.
• In-depth understanding of the hospitals processes, policies and procedures
• Verify Medical, billing related documents for further claim processing.