Manager - Health Claims

A Medical Reviewer at Prudent Insurance Brokers is responsible for reviewing medical information and data related to insurance claims. You will ensure accuracy, completeness, and compliance with relevant regulations. Your main tasks will involve 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. You will be expected to: - Analyze medical records, reports, and data to assess the validity and accuracy of insurance claims. - Ensure that all medical information and claim processing adheres to relevant regulations and standards. - Determine the legitimacy of claims based on medical evidence and insurance policies. - Collaborate with internal teams (claims, operations, sales) and external stakeholders (clients, medical professionals). - Generate reports and documentation related to reviewed claims. - Stay updated on medical advancements and regulatory changes to enhance processes. The ideal candidate should possess the following 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. Qualifications required for this position include MBBS/BHMS/BAMS/BUMS/BDS with a background in TPA/Insurance Company/Brokers and good medical knowledge. The ideal candidate should have 3-5 years of experience in claims (cashless/reimbursement).,