Description

*Job Title : Medical Coder – Insurance Claims* *Company* : Medi Assist Insurance TPA Pvt. Ltd. *Experience* : Freshers / Entry Level *Qualification* : BHMS / BAMS / BDS / BPT *Job Locations* : Bengaluru, Mumbai, Noida *CTC* : ₹3.55 LPA *About the Company* Medi Assist Insurance TPA Pvt. Ltd. is one of India’s leading HealthTech and InsurTech organizations providing Third Party Administration (TPA) services to insurance companies. The company acts as an intermediary between insurers, policyholders, and healthcare providers, managing health benefits and claims administration efficiently. With a network of 18,000+ hospitals across 1,069 cities and towns in 31 states and union territories, Medi Assist delivers seamless healthcare benefits management for employers, retail policyholders, and government health schemes through its subsidiaries Medi Assist TPA and Raksha TPA. *Key Responsibilities* * Review and analyze medical records and insurance claims to ensure accurate coding and claim assessment. * Interpret ICD coding and verify diagnosis and treatment documentation. * Scrutinize claims in accordance with insurance policy terms and conditions. * Evaluate co-payment details, room rent eligibility, non-medical expenses, and tariff capping. * Differentiate between open billing and package billing structures. * Understand and process Pre-Authorization (PA) and Reimbursement (RI) claims as per guidelines. * Verify required documents for claim processing and raise Information Requests (IR) in case of missing or insufficient documentation. * Coordinate with internal teams such as the LCM team for high-value billing queries and provider teams for tariff-related issues. * Approve or recommend denial of claims within the defined Turnaround Time (TAT) as per policy guidelines. * Handle escalations and respond to claim-related queries through internal communication channels. *Required Skills & Competencies* * Strong understanding of medical terminology and clinical documentation * Basic knowledge of ICD coding and medical billing processes * Analytical and decision-making skills * Attention to detail in reviewing medical and insurance documents * Good communication and email etiquette * Ability to work in rotational shifts and meet claim processing timeline Regards, Placement Team Henry Harvin Education

Role and Responsibilities

• * Review and analyze medical records and insurance claims to ensure accurate coding and claim assessment. * Interpret ICD coding and verify diagnosis and treatment documentation. * Scrutinize claims in accordance with insurance policy terms and conditions. * Evaluate co-payment details, room rent eligibility, non-medical expenses, and tariff capping. * Differentiate between open billing and package billing structures. * Understand and process Pre-Authorization (PA) and Reimbursement (RI) claims as per guidelines. * Verify required documents for claim processing and raise Information Requests (IR) in case of missing or insufficient documentation. * Coordinate with internal teams such as the LCM team for high-value billing queries and provider teams for tariff-related issues. * Approve or recommend denial of claims within the defined Turnaround Time (TAT) as per policy guidelines. * Handle escalations and respond to claim-related queries through internal communication channels.