Processing of cashless / reimbursement claims request received from the hospital.
Proper scrutiny of the medical documents received from the hospital/ patient and ask for relevant details to corroborate with the available diagnosis.
Review the treatment details/ medication regimen given during hospitalization and ask for justification from treating doctor if treatment protocol is not appropriate to the diagnosis.
Collate the medical details with the applicable policy terms to arrive at the final decision of claims adjudication. 5. Handling grievances effectively.