Work as Medical Insurance Doctor / RCM Doctor:• Medical review of the claims and approvals process.• Submission and resubmission the claims.• Medical Approvals handling and audit.• Medical Coordinator with different department.• Discuss Patients treatment plan with the treating medical team and audit treatment costs/invoices to ensure maximum cost containment.• Support the department’s efforts to achieve cost containment.• Complete appropriate electronic forms with detailed benefit and pre-certification/ authorization information to ensure a clean claim.• correctly coding diagnosis and procedures.• Adjudicating and processing complex inpatient pre-approvals cases following best medical practices and claims handbooks within theagreed TAT pre line of business.• Implement Case Management concept to hand hold members in their medical journey and ensuring proper treatment plan is being providedbased on first class medical protocols.• Medical records audits for Inpatient ongoing case.• Retrospective open file reviews.• Undeclared pre-ex conditions onsite investigation.• keeping up to date with latest regulatory changes liaise with other internal stake holders to ensure implementations are within scope.• Assist the team in regulatory escalations, providing required information for cases re-assessment.• Supervising the Non Medical team in achieving the required level of maturity in medical inline with the set objectives of the role.• Onsite hospital Roaming and case Management.