 Loss intimation of IPD pre-authorizations.
 Checking insurance coverage of clients as per provided data in pre-authorization form.
 Coordinate with in-house doctors for sending approvals and limit enhancements to panel hospitals.
 Correspondence with panel hospitals regarding approvals and outstanding bills.
 Coordinate with case managers regarding requirements, case management report and hotline rejections.
 Coordinate with contact members of panel hospitals for services providing to their clients and status of admitted patients.
 Respond to clients / hospitals quarries over phone, email, and letters.
 Making relationships with hospitals regarding new enlistments of hospitals and their rates negotiation.
 Maintaining weekly basis data of admissions, rejections and limit enhancements.
 Final month end posting of pre-authorizations.
 Maintains filing and tracking of intimations on daily basis.

 Loss intimation of IPD/OPD reimbursement claims.
 Scrutiny of claims and calculation of claimed and payable amount.
 Coordinate with in-house doctor about claims and any other related quarries.
 Settlement of claims within timeline in case of no requirement.
Sending emails to concerned members and update requirement remarks in the system.
 On receipt of requirement get the claim re-evaluated by in-house doctor.
 Respond to client quarries over phone, email, and letters.
 Coordinate with finance department regarding cheque signing and payment queries.
 Loss intimation of credit outpatient claims.
 Final month end posting of claims.
 Providing claim details to clients in case of a request.
 Maintaining file record in the system of paid and requirement claims.

 Claim intimation of reimbursement claims.
 Scrutiny of claims and calculation of claimed and payable amount.
 Coordinate with in-house doctor about claims and any other related quarries.
 Settlement of claims within timelines in case of no requirement.
 In case of requirement, sent emails to concerned member and update requirement remarks in the system.
 On receipt of requirement get the claim re-evaluated by in-house doctor.
 Respond to client quarries over phone, email, and letters.
 Claim intimation of credit outpatient claims.
 Final month end posting of claims.
 In case of a request, share claim details with client after approval from in-house doctor.