Veterinary Officer

The Veterinary Officer is responsible for reviewing, assessing, and validating pet insurance claims to ensure they comply with policy terms and veterinary best practices. The role involves medical evaluation of treatment plans, cost assessments, fraud detection, and providing expert guidance on underwriting and claims decisions.

Key Responsibilities

1. Claims Assessment & Review

• Evaluate veterinary medical records, diagnostic reports, and treatment plans.
• Assess claim eligibility based on policy coverage, exclusions, and limits.
• Determine the medical necessity and appropriateness of treatments and procedures.
• Approve, partially approve, or decline claims with clear justification.

2. Medical Advisory

• Provide expert veterinary opinions on complex or disputed claims.
• Support underwriting teams with medical risk assessments.
• Advise on pre-existing conditions, chronic diseases, and hereditary disorders.
• Develop medical guidelines for claims consistency and fairness.

3. Cost & Fraud Analysis

• Review treatment costs for reasonableness and alignment with market standards.
• Identify potential over-servicing, misrepresentation, or fraudulent claims.
• Collaborate with fraud investigation teams when necessary.

4. Stakeholder Communication

• Communicate claim decisions clearly to internal teams and, when required, to policyholders or veterinary clinics.
• Respond to appeals and provide detailed medical justifications.
• Build professional relationships with veterinary service providers.

5. Policy & Process Development

• Assist in drafting and updating medical policies and underwriting criteria.
• Contribute to claims automation rules and decision-making frameworks.

Participate in quality assurance audits and compliance checks.

• Degree in Veterinary Medicine (DVM or equivalent).
• Valid veterinary license in good standing.
• Experience in insurance, claims review, or underwriting (preferred but not mandatory).

Minimum 3–5 years of clinical veterinary experience (small animal practice preferred).

• Strong understanding of diagnostic procedures, treatment protocols, and veterinary billing practices.
• Excellent analytical and decision-making skills.
• Strong written and verbal communication skills.
• Proficiency in claims management systems and standard office software