Looking For Health Claims Doctor @ ICICI Lombard

ICICI Lombard

2 - 6 years

2 - 5 Lacs

thane navi mumbai mumbai (all areas)

Posted:2 weeks ago| Platform:

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Skills Required

tpa medical underwriting claims adjudication claims processing health insurance health claims customer service claims management medical officer claim settlement claim investigation

Work Mode

Work from Office

Job Type

Full Time

Job Description

Job Summary:

medical professional

Key Responsibilities:

Medical Review & Claims Adjudication:
Assess and validate medical claims based on clinical documentation and policy coverage.
Interpret diagnostic reports, treatment plans, and prescriptions to determine claim eligibility.
Coordinate with internal medical teams to ensure accuracy in claims decision-making.
Customer Interaction & Support:
Communicate with policyholders, hospitals, and third-party administrators (TPAs) to explain claim decisions in a clear and professional manner.
Handle escalated or complex customer service issues involving medical claims.
Offer support and guidance on claim submission processes and documentation requirements.
Compliance & Documentation:
Ensure all claims are processed in compliance with IRDAI regulations and internal guidelines.
Maintain accurate records of claim assessments, approvals, denials, and communications.

Required Qualifications:

Education:
MBBS, BDS, BHMS, BAMS, or equivalent medical degree. Postgraduate qualifications in healthcare or insurance are a plus.

Experience:
Minimum 2
5 years
of experience in
health insurance
, especially in
claims processing, medical underwriting
, or
TPA operations
.
Proven track record of
customer service experience
in a healthcare or insurance setting.

Skills:
Strong clinical judgment and attention to detail.
Excellent communication and interpersonal skills.
Proficient in claims management systems and MS Office.
Ability to handle sensitive medical information with confidentiality and professionalism.

Regards,

Human Resource

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