Medical Assessor

As a Medical Doctor, your main responsibility will involve the processing of health claims according to the standard operating procedures and guidelines provided. It is essential to achieve the expected productivity on a daily basis while maintaining high-quality standards. You will need to be vigilant in identifying fraud triggers and possible leakages to prevent any misuse. Having a thorough understanding of health claims processing is crucial for this role. It is important to stay updated with the latest regulations and their implications to ensure compliance. Adherence to the prescribed turnaround times for each category is necessary to meet the service level agreements. Your role will require comprehensive medical knowledge and proficiency in clinical treatment protocols. You should be capable of interpreting and analyzing information related to medications in correlation with the diagnosis. A clear understanding of ICD codes and procedure codes is essential for accurate claims processing. In situations where there is a potential for inflation or abuse, you will be responsible for case management to address such issues effectively. Additionally, being able to interpret product wordings to make appropriate claims decisions is a key aspect of this role.,