Sr Associate - Health claims (CL&MR)

Key Responsibilities File Review & Assessment Review all open claim files assigned (cashless & reimbursement). Verify completeness of documentation (pre-authorization forms, discharge summaries, bills, prescriptions, investigation reports, etc.). Check for missing or inconsistent information and initiate follow-ups with hospitals, TPAs, or claimants. Evaluate medical necessity of treatments against standard guidelines and policy coverage. Identify any non-payable items, exclusions, or excess bi…