PA- Claims Assessor
To assess claims products to ensure that benefit spend is in accordance with the policies and rules relevant to our members policies and contracted agreements with providers of Healthcare.
Data Entry of Information related to personal details, provider details, invoice information, procedure & impairment codes
Validation of information entered by indexer
Check & Select correct Preauthorization
Identify duplicate Claims and take appropriate action
Reading & taking appropriate action on Alerts related to Members & providers.
Referring case to calling team for further information
Validating information entered by data Entry Operator
Dealing with Policy & Non Policy messages
Interpreting, analyzing & further investigating the Policy messages on various tools like support point, info site etc.
Interpretation of hospital contracts & taking appropriate action basis that
Referring cases to various department like HCS,TMT, Triage after adjudication as and when required
Identify any over charge, ineligible chargers, contract compliance, Provider or Member Fraud
B.Sc. Life Science
Good knowledge of healthcare & medical terminologies
Eye for detail & investigative skills
Good interpretation & comprehension skills