Medical Assessor - Outpatient Precertification
Medical Officer – Outpatient Precertification is responsible for managing the Outpatient Precertification claims while ensuring that departmental goals, timeline of activities, and compliance measures are met.
What you do
•Precertification team is functional on 24/7 basis. Therefore, the Medical Officer will work on a flexible shift basis as per the schedule provided by the Team Leader.
•Adjudicates - outpatient medical claims by evaluating each case from both the technical and clinical perspectives, ensuring all decisions comply with policy terms and conditions and are delivered within the stipulated turnaround time and quality standards.
•Performs a comprehensive review of outpatient documentation, including consultation notes, diagnostic reports, laboratory results, radiology findings, prescriptions, treatment plans, and follow‑up notes to validate medical...