Manager - Health Claims (Medico)

A Medical Reviewer at Prudent Insurance Brokers is responsible for reviewing medical information and data related to insurance claims to ensure accuracy, completeness, and compliance with relevant regulations. You will be analyzing medical reports, documents, and data to determine the validity of claims and provide recommendations for claim processing. This role necessitates a strong understanding of medical terminology, clinical practices, and insurance regulations. Key Responsibilities: - Analyzing medical records, reports, and data to assess the validity and accuracy of insurance claims. - Ensuring that all medical information and claim processing adhere to relevant regulations and standards. - Determining the legitimacy of claims based on medical evidence and insurance policies. - Collaborating with internal teams (claims, operations, sales) and external stakeholders (clients, medical professionals). - Generating reports and documentation related to reviewed claims. - Staying updated on medical advancements and regulatory changes to enhance processes. Required Skills: - Medical Knowledge: Strong understanding of medical terminology, anatomy, physiology, and common medical conditions. - Critical Thinking: Ability to analyze data, identify inconsistencies, and make sound judgments. - Communication: Effective verbal and written communication skills to interact with clients and colleagues. - Attention to Detail: Meticulous approach to ensure accuracy and completeness in all work. - Regulatory Compliance: Knowledge of relevant insurance regulations and standards. - Problem-Solving: Ability to identify and resolve discrepancies or issues within claims. Qualification required: MBBS/BHMS/BAMS/BUMS/BDS (with TPA/Insurance Company/Brokers background and good medical knowledge) Experience Required: 3-5 years in claims (cashless/reimbursement),