Description

The Company

A Life insurer - Hospital/Out-patient claims (up to 26k)

The Role

1. Claims Assessment: Evaluate inpatient, outpatient, and surgical claims against policy terms, pre-authorizations, and coverage exclusions.
2. Invoice & Medical Review: Examine hospital bills, itemized receipts, and discharge summaries to verify medical necessity and identify non-payable or inflated charges.
3. Stakeholder Coordination: Communicate with hospitals, clinics, and policyholders to obtain missing documentation and resolve claim inquiries.
4. Direct Billing: Manage Guarantee of Payment (GOP) processes for hospital admissions and major outpatient treatments.
5. Fraud & Quality Control: Identify potential fraud, waste, or billing errors, escalating red flags to management or investigation teams.
6. System Entry: Maintain accurate record-keeping of diagnosis codes (ICD-10/CPT) and claim decisions within operational SLAs.

Your Profile

Education & Experience

• Experience: 2+ years in health insurance claims adjudication, TPA operations, or hospital billing.

Technical & Professional Skills

• Good knowledge of insurance products and policy administration processes
• Proficient in Microsoft Office (Excel, Word, Outlook)
• Knowledge of ILAS products and regulatory requirements is an advantage

Apply Today

To apply online (Word attachment only), please click the 'Apply' button. Please note that only short-listed candidates will be contacted.

Reference Number: 67010-0013477395

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