Asst. Manager/ Manager - Health Claims

As a Medical Reviewer at Prudent Insurance Brokers, your primary responsibility will be to review medical information and data pertaining to insurance claims. It will be crucial for you to ensure that the information is accurate, complete, and compliant with the relevant regulations. Your role will involve analyzing medical reports, documents, and data to validate claims and offer recommendations for their processing. An in-depth understanding of medical terminology, clinical practices, and insurance regulations will be essential for this position. Your key responsibilities will include assessing the validity and accuracy of insurance claims by analyzing medical records, reports, and data. It will be important to guarantee that all medical information and claim processing align with the applicable regulations and standards. You will need to evaluate the legitimacy of claims based on medical evidence and insurance policies, collaborating with internal teams like claims, operations, and sales, as well as external stakeholders such as clients and medical professionals. Additionally, you will be expected to produce reports and documentation related to the reviewed claims and stay informed about medical advancements and regulatory changes to enhance the processes. To excel in this role, you should possess a strong grasp of medical terminology, anatomy, physiology, and common medical conditions. Critical thinking skills will be necessary to analyze data, detect inconsistencies, and make informed decisions. Effective verbal and written communication abilities will play a vital role in your interactions with clients and colleagues. Attention to detail is crucial to ensure accuracy and completeness in all your work, along with a solid understanding of relevant insurance regulations and standards. Your problem-solving skills will be put to the test as you identify and address discrepancies or issues within claims. The ideal candidate for this position should hold a qualification of MBBS/BHMS/BAMS/BUMS/BDS, preferably with a background in TPA/Insurance Company/Brokers and a strong medical knowledge base. A minimum of 3-5 years of experience in claims, specifically in cashless or reimbursement processes, will be required to succeed in this role.,