Sr. Associate OPD claim handler
ACKO
About Job
Claim handler working on OPD (Outpatient Department) claims,
Skills & Qualification
Medical background
Healthcare expertise
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Strong analytical and attention-to-detail skills
Ability to identify policy compliance issues or mismatched documentation
Clear and professional email communication with customers and internal teams
Ownership of cases until closure (especially when follow-up documents are pending)
Responsibilities
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· Understanding of OPD coverage under different policy types (corporate, retail, etc.).
· Ability to interpret policy terms, sub-limits, and exclusions related to OPD.
· Familiarity with standard treatment and diagnostic codes (ICD, CPT, or similar).
· Knowledge of claim processing workflows — from registration to adjudication and payment.
· Awareness of fraud indicators (e.g., repeated consultations, manipulated invoices, or fabricated prescriptions).
Proficiency in the claim processing system
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