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BA Healthcare Domain Interview Questions
BA Healthcare Domain Interview Questions
BA Healthcare Domain Interview Questions
The claims executive will then check the bills and claims from the insured/hospital to see if the
benefits are covered for or there are areas on which he is not covered for. If the claim is eligible,
then the payout amount is calculated based on what he’s eligible for and what he has filed in.
This payout amount will be forwarded to the Finance department for a final payout via any
chosen method.
What are the methods by which detection of fraud can be done in healthcare claims from
the system's perspective?
With uniqueness of each healthcare claim being maintained intra insurer as well as inter
insurance companies can go a long way in identifying claim frauds. If the systems can
detect the same parameters for the claim as has been done previously , then the fraud can
be stopped. The parameters can be hospital bill number, the date of hospitalization or the
amount being claimed etc.