Doctor - Insurance Management

Job Description

Desired Qualification: BDS/BAMS/BHMS The Insurance Medical Officer (IMO) is a key member of the Insurance Team responsible for the servicing of Patients from Insurance, ESI, ECHS The MIO will provide opinions and recommendations in the co-ordination of medical case management. This relates to broad medical issues including liaising with treating medical officers. The MIO will be involved in the assessment of complex claims cases to ascertain pre existing elements and validity of the claim. The MIO will provide support to the insurance division in the assessment of cancellation claims and the provision of medical reports and will also provide medical assessment for Insurance ,ESI and ECHS cases where required, as per direction from the Hospital Authorities. Technical/Functional Competency: · Should demonstrate excellent inter-personal and communication skills, and be able to communicate in a way which assists understanding. · Should be certified to provide BLS. Must have a working knowledge of the use of personal computers. · Examine the patients, and record the history in EMR, in a safe, compassionate and ethical manner and in compliance with Good Medical Practice. · Request investigations, and record the results in the medical chart. · Conduct daily ward rounds, and record the notes about patient progress and health status. · Work according to the management plan approved by the registrar / consultant in-charge · Work as a team member during the on-call duties to ensure organization of comprehensive patient management. · Assist senior members of the team in performing invasive procedures. · Handle common clinical scenarios and emergency situations such as, cardio-pulmonary resuscitation, and then communicate with the senior members of the team. · Liaise with the clinical services committee of the department. · Maintain accurate medical records. · Adhere to quality indicators, TAT and protocols for the dept. · Adhere to prescribed infection control standards · Ensure that medical information provided in cashless documents are correct and not contradictory or all relevant information including patient history/preexisting conditions are presented in request form/Case sheet/discharge summary/query response etc. · Support the billing team in selecting surgery packages · Ensure claims are approved and settled , chances for queries or rejections during settlement to be avoided and high value claims or package deviations are stated with supporting OT notes /progress notes etc · Oversee the department al functioning report to Head Medical services on operational lags/issues/ patient grievance /staff performance etc · Provide MIS – Daily/weekly/monthly · Identify areas of process optimization · Ensure timely documentation and submission of reports · Ensure that there are no medico legal issues due to errors and negligence in the dept. In case of such issues, take complete ownership to resolve the matter · Ensure to keep abreast with latest developments in his/her area · Demonstrate evidence of successful participation in mandatory courses required by the Hospital. · Participate in the training activities Job Type: Full-time Pay: ₹15,000.00 - ₹18,000.00 per month Schedule: Day shift Supplemental Pay: Performance bonus Education: Bachelor's (Required) Experience: total work: 1 year (Preferred) Management: 1 year (Preferred) Work Location: In person Application Deadline: 17/06/2025 Expected Start Date: 20/06/2025