Job Description
The Medical Helpdesk Support is responsible for reviewing and assessing medical claims from a clinical perspective to ensure treatments, diagnoses, and hospitalizations are appropriate and aligned with medical guidelines and company policies. The role supports pre-approval requests, reviews medical records and supporting documents, and works closely with hospitals and internal teams to clarify claim information and support claim decisions.
The role requires strong clinical judgment, attention to detail, and the ability to interpret medical information while helping ensure a fair, accurate, and efficient claims assessment process.
**Position Responsibilities:**
+ Review and assess medical claims (reimbursement, and cashless) from a clinical perspective.
+ Validate appropriateness of diagnosis, treatment, and hospitalization based on nursing and medical guidelines.
+ Support pre-approval (pre-authorization) processes for hospital and non-hospital cases.
The role requires strong clinical judgment, attention to detail, and the ability to interpret medical information while helping ensure a fair, accurate, and efficient claims assessment process.
**Position Responsibilities:**
+ Review and assess medical claims (reimbursement, and cashless) from a clinical perspective.
+ Validate appropriateness of diagnosis, treatment, and hospitalization based on nursing and medical guidelines.
+ Support pre-approval (pre-authorization) processes for hospital and non-hospital cases.
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