Medical Coordinator

Job Description:

About company :

Falck (www.falck.com) for more than a century, has been helping people and societies to live in a safe and healthy environment. We are committed to advancing sustainable healthcare, and every step we take is dedicated to making life better, safer, and healthier. In a world of constant changes, peoples needs, and expectations keep evolving- except for the need for good health and feeling safe. Through our varied offers of healthcare and emergency health and safety services, we have made it our responsibility to help even more people around the world live healthy lives.

Job description:

1. Ensure customer satisfaction of the highest order for all medical projects and services as assigned by the organization.
2. Maintain and continually improve the quality of medical service delivery.
3. Ensure that there is alignment and cooperation between medical team and operations team for seamless execution of designated projects and services.
4. Scrutiny of medical documents and adjudication of the international travel insurance policy holders.
5. Assess the eligibility of international travel insurance related medical claims and determine financial outcomes.
6. Determine accuracy of medical documents.
7. Processing the case as per policy terms & condition of the respective insurance companies.
8. Coordinating & communicating with the other departments for processing the claim.
9. Coordinating with insurance company for specific approvals.
10. Handling the grievance related to the medical rejection/ denial of the Cashless request as well as re reimbursement claims.
11. Providing the Quality services by keeping the minimum TAT.
12. Involved in Analyzing Medical Reports to Process Medical Claims.
13. Any other roles and responsibilities assigned form time to time related to the medical projects being managed by the organization beyond international travel insurance.

Education and experience: BAMS/BHMS having experience with TPA