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Medical Officer @ HealthIndia Insurance

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 Medical Officer

Job Description

Job description

URGENT OPENING FOR MEDICAL OFFICER


Workings Hours: 9 Hrs

Work Mode : Office

Key Responsibilities:

  • Review and assess medical claims submitted by corporate clients against policy terms and medical guidelines.
  • Analyze clinical documents such as medical reports, diagnostic tests, prescriptions, discharge summaries, and other relevant medical records.
  • Verify the authenticity, appropriateness, and completeness of medical documentation related to claims.
  • Provide medical expertise to determine the validity and admissibility of claims.
  • Collaborate with claims processing and underwriting teams to resolve discrepancies or clarifications related to medical information.
  • Identify potential fraud, over-utilization, or discrepancies in claims through thorough medical evaluation.
  • Maintain up-to-date knowledge of medical terminologies, treatment protocols, and emerging health trends relevant to claims assessment.
  • Assist in developing and updating medical claim processing guidelines and protocols.
  • Support training and capacity-building activities for claims staff on medical aspects of claims.
  • Ensure compliance with regulatory and company policies during claims assessment.
  • Communicate effectively with healthcare providers, corporate clients, and internal teams to clarify medical information as needed.
  • Generate detailed reports and documentation on claim assessments and decisions.

Qualification:

BHMS, BMS


Job Classification

Industry: Insurance
Functional Area / Department: Healthcare & Life Sciences
Role Category: Healthcare & Life Sciences - Other
Role: Healthcare & Life Sciences - Other
Employement Type: Full time

Contact Details:

Company: HealthIndia Insurance
Location(s): Hyderabad

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Keyskills:   Claims Processing reimburment Mediclaim Insurance Claims TPA Cashless Medical Insurance Medical Billing Medical Claims Health Insurance

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₹ -4.25 Lacs P.A

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HealthIndia Insurance

HealthIndia Insurance TPA Services Pvt. Ltd. was established in year 2002; with the mission to provide top quality TPA services to clients. We are licensed by IRDA (Insurance Regulatory & Development Authority - License No. 022).