Medical Officer - Non Clinical Role

Medical Officer / Consultant (Work From Office Only)

Location: Mumbai / Bangalore

Experience: 0 to 3 Years

Qualification: BAMS / BHMS / BSc Nursing , B pharm/M pharm with TPA Experience

We are looking for Medical Officers to review and process health insurance claims by applying medical knowledge and policy guidelines. The role involves evaluating medical admissibility, scrutinizing claim documents, and ensuring timely and accurate claim decisions.

Key Responsibilities:

• Assess medical claims and verify diagnosis, treatment details, and admissibility.
• Review claims as per insurance policy terms and conditions.
• Evaluate ICD coding, co-payments, non-medical expenses, room rent limits, and package charges.
• Verify supporting documents and raise requirements for incomplete cases.
• Coordinate with internal teams for claim-related clarifications and escalations.
• Approve or deny claims within defined turnaround times (TAT).
• Handle claim-related queries and email communications.

Desired Candidate Profile:

• BAMS, BHMS, or BSc Nursing
• Strong analytical and decision-making skills.
• Good communication and computer proficiency.
• Freshers and candidates with up to 3 years of experience in Healthcare, Hospitals, Insurance, or TPA industry may apply.

Interested candidates may send their CV to [email removed] OR WhatsApp to [phone removed]