Job Description & How to Apply Below
● Review and process medical documentation and insurance claims to ensure accuracy, completeness, and compliance.
● Analyze patient information, laboratory findings, and treatment histories for risk assessment and decision-making.
● Determine coverage eligibility, exclusions, and appropriate premium modifications based on health risk profiles.
● Collaborate with healthcare providers, policyholders, and team members to resolve discrepancies and communicate outcomes.
● Guide acceptance or rejection of health proposals, applying robust risk evaluation techniques and recommending appropriate risk loading when necessary.
● Extract insights from Claims MIS and use data analytics to enhance underwriting
decisions.
● Monitor regulatory changes and industry trends to continuously improve risk evaluation processes.
● Contribute innovative ideas for process optimization and risk mitigation.
Required Skills & Competencies
● Strong foundation in medical science and clinical documentation.
● Expertise in health risk underwriting and claims assessment.
● Analytical mindset, detail orientation, and critical thinking skills.
● Ability to communicate clearly and collaborate with diverse stakeholders.
● Experience extracting and interpreting insights from claims data systems.
● Creative problem-solver, open to process innovation and improvement.
Qualification required: BAMS, BHMS
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