<ul><li>Check the medical admissibility of a claim by confirming the diagnosis and treatment details.</li><li>Scrutinize the claims, as per the terms and conditions of the insurance policy</li><li>Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc.</li><li>Understand the process difference between PA and an RI claim and verify the necessary details accordingly.</li><li>Verify the required documents for processing claims and raise an IR in case of an insufficiency.</li><li>Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff.</li></ul>

Medical Officer