17 Feb

Medical Officer Management Tpa - Delhi - Apollo Health Resources Limited

Position
Medical Officer Management Tpa
Company
Apollo Health Resources Limited
Location
Delhi DL
Opening
17 Feb, 2017 7 days ago

Apollo Health Resources Limited as the company that open the jobs vacancy, have some qualification and spesification especially for the Medical Officer Management Tpa jobs vacancy. To find out more information and about qualification and spesification details, walkin interview schedule, the address of the company, the company contact info (email/phone number) of Apollo Health Resources Limited company, please start to apply for the job vacancy with fill the jobs application with click the 'Apply This Job' button below.

Pre-Authorization of Cashless and reimbursement request & Claims scrutiny or reviewing claims files in light of policy T & C of various insurance companies.

  • Interaction with Health Care Providers & Coordination with internal - external teams in processing the cases .
  • Medical scrutinizing, assessing and admissibility of medical claims, (Indian Subsidiary of WAPMED-Kuwait, Dubai, Abudabhi).
  • E-Claims (Electronic Claims ) - these claims are receiving from Dubai and Abu Dhabi & Medical scrutinizing of these claims which comes in ICD-9 and ICD-10 format & CPT Codes Standardized by DHA, HAAD & following the guidelines pertaining to Insurance Companies of Middle East like Al Ain Ahlia Insurance Company, INTERGLOBAL, AETNA, WARBA, RITAJ, Takaful Emarat Insurance etc.
  • Paper / Physical Claims from Kuwait which comes in PDF format & Process claims as per healthcare guidelines by maintaining daily productivity.
  • Well versed in proceeding of reimbursement claims of DHA HAAD & Indian Insurance claims.
  • Commercial audit, Medical audit of claims and raising IR (information required) & issuing for PR (payment request).
  • Generating claim IDs for data processing & thorough knowledge regarding claims validation & in final audit.
  • Knowledge of policy concepts like Deductible, Coinsurance, Co-pay, and following plan guides for referring Policy benefit Exclusions in processing of claims.
  • Continuous Quality improvement in Health Claims Processes & Maintaining TAT (Turn Around Time) for claims settlement.

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