Medical Officer Anand Rathi Insurance Brokers Ltd

4.0 - 8.0 years

0 Lacs

maharashtra

On-site

You are a qualified and experienced medical professional sought to join the insurance operations team to handle and review Group Personal Accident (GPA) and Group Mediclaim (GMC) claims. Your responsibilities include ensuring the accuracy and appropriateness of claims, resolving medical disputes, addressing client grievances, and providing expert support in claim-related discussions with insurers and clients. Your key responsibilities will involve scrutinizing GPA and GMC claims from a medical perspective, handling disputed or complex claims such as accidental disability or death due to medical or accidental causes, and liaising with insurance company doctors and TPAs to resolve disputes based on clinical merit. Furthermore, you will be responsible for managing medical grievances, addressing customer concerns with medical aspects or claim rejections, and coordinating with corporate clients, insurance company medical teams, TPAs, and legal teams when necessary to ensure clarity and resolution on medical matters. Maintaining detailed and confidential medical case notes for claims handled, documenting recommendations, approvals, and medical assessments, and ensuring alignment with internal policies and industry regulations will also be part of your duties. To excel in this role, you should possess strong clinical evaluation and documentation review skills, a good understanding of insurance terms and claims processes, the ability to assess disability and accidental claims from a medico-legal standpoint, excellent communication and interpersonal skills, and a problem-solving mindset with attention to medical and procedural details. Your qualifications should include an MBBS/BAMS/BHMS degree, with additional qualifications in insurance or healthcare administration being advantageous. You should have at least 3-5 years of experience in medical claims review in the insurance or TPA industry, along with familiarity with claim adjudication processes in Group Health and Personal Accident Insurance.,

Posted 2 days ago

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