Job Status : Closed
As a Senior Officer in In-Patient Approvals, you will manage the pre-approval process for in-patient services. Key responsibilities include evaluating pre-approval requests, verifying member eligibility, and authorizing claims per policy terms. Your expertise in DRG and IP approvals will ensure cost-effective and profitable decisions, following a pre-defined approval claim matrix to maintain operational efficiency and consistency.
ππππππ ππππππππ, ππππππ & ππππππππππ:
1. Graduate in Medical field – MBBS
2. At least 2-3 years experience in claims management and approval process in health insurance or TPA industry
3. Medical terminologies & medical coding is a plus.
4. Knowledge of third-party administration/insurance is mandatory
πππ ππππππππππππππππ:
1. Receive pre-approval requests through the portal or mail as advised by the Physician.
2. Evaluate claims and provide authorizations for insured members, aiming for cost-effective and profitable outcomes.
3. Verify member eligibility according to policy terms and conditions, approving or rejecting based on standard operating protocols.
4. Utilize sound knowledge of DRG and IP approvals to adjudicate requests.
5. Follow the pre-defined approval claim matrix to ensure effective operations.
6. Sense of ownership and commitment to work, Conscientious with positive work ethic, high integrity, trustworthy and honest.
