Healthcare Assistant

Job Duties & Responsibilities 

• Play as an intermediate role Between the Insurance co. and Hospital and We Assist Team. 

• Adjudicating cashless and Reimbursement claims with claim documents provided by help desk executive.  

• Should be able to do claim tabulation to bifurcate payable and non-payable items as per the terms and conditions laid out in the insurance policy. 

• Evaluating claims and posting remarks in what’s app group and updating in CRM.  

• Monitoring billing as per the Tariff. 

• Managing claims escalations from hospitals. 

• Responsible to handling queries raised by insurance company / TPAs 

• Provide technical assistance and conduct training sessions for new processors on various health insurance policies. 

• Evaluate complete claim documents before submission. 

• Final Approval of Tabulation done by the team 

• Coordinate with the Internal team to understand patient enquiries.  

• Helping team to understand the Non-medical Items. 

• Periodically educating the claim assistance department about the changes in the policy, rules & regulations and application deduction on settlement.    

• To create awareness about reimbursement claims. (Pre, Post & Hospitalization) and communicating the important updates to the Claims Assistance and Finance Department 

• Be available at the office for supporting onsite staff on all six days in a week b/w 9.30am to 7.00pm 

• Efficiently and effectively handle grievance / issue raised by hospital staff & patients, escalate issue to the team leader, Manager – Insurance Adjudication and Business Head as necessary. 

• Follow-up on the updates to be given to the clients / onsite team of Claims Assistance Department 

Qualifications & Skills. 

• BAMS / BHMS / BDS / Bsc / MSc / Nursing / Dpharm / Bpharm  

• 0 -2 years of relevant experience 

• Should have good analytical skills 

• Excellent interpersonal & communication skills 

• It is a Full Time Trainer job for candidates with 0 - 1 years of experience.