Medical Officer
- ICICI Lombard
- 10 - 15 years
- Hyderabad
- 17 days ago
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Job Description
Job Summary:
We are seeking a qualified and experienced medical professional with a strong background in health insurance claim settlement and customer service. The ideal candidate will leverage their clinical knowledge to evaluate and process health insurance claims efficiently while ensuring a high level of customer satisfaction. This hybrid role bridges the gap between medical accuracy, regulatory compliance, and empathetic customer support.
Job Title: Chief Manager
Key Responsibilities:
- Medical Review & Claims Adjudication:
- Assess and validate medical claims based on clinical documentation and policy coverage.
- Interpret diagnostic reports, treatment plans, and prescriptions to determine claim eligibility.
- Coordinate with internal medical teams to ensure accuracy in claims decision-making.
- Customer Interaction & Support: Customer Calling - In Bound / Out Bound
- Communicate with policyholders, hospitals, and third-party administrators (TPAs) to explain claim decisions in a clear and professional manner.
- Handle escalated or complex customer service issues involving medical claims.
- Offer support and guidance on claim submission processes and documentation requirements.
- Compliance & Documentation:
- Ensure all claims are processed in compliance with IRDAI regulations and internal guidelines.
- Maintain accurate records of claim assessments, approvals, denials, and communications.
- Grade : IV-B
Required Qualifications:
- Education:
- MBBS, BDS, BHMS, BAMS, or equivalent medical degree. Postgraduate qualifications in healthcare or insurance are a plus.
- Experience: 10-15 Years of Experience in Health Claims/Underwriting/Products/IT Process etc. Having an direct/indirect exposure to call center, and interest towards customer calling team.
Location: Varun Towers II, 6th Floor, Begumpet, Hyderabad.
Conatct Person: Pramod / Chaitanya
8108014***/ 8977658***
Job Classification
Industry: InsuranceFunctional Area / Department: Healthcare & Life SciencesRole Category: DoctorRole: Chief Medical OfficerEmployement Type: Full timeContact Details:
Company: ICICI LombardLocation(s): Hyderabad
Keyskills: Team Handling Doctor Activities Stakeholder Management
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