Medical Officer - Claim Processing

Dear Candidates,

Greetings from HealthIndia Insurance TPA Service Pvt. Ltd.

Company Profile - We are providing highest level of quality health care by creating a platform which is entirely dedicated to service excellence, patient care and health education to the members .

For more details kindly go through company website: https://www.healthindiatpa.com

Currently we have an opening in Claim Processing Department for Medical Officer Role.

Location: HealthIndia Insurance TPA Services Pvt. Ltd.

406-412, Neelkanth Corporate IT Park, 4th Floor, Kirol Road/ Village,

Vidyavihar (West), Mumbai 400086.

Key Responsibilities:

• Review and assess medical documents for insurance claims.
• Verify authenticity of medical reports and diagnostics
• Evaluate medical necessity as per policy terms
• Offer expert opinions on complex/disputed cases
• Collaborate with internal teams for seamless claim processing
• Identify potential fraud or discrepancies
• Liaise with providers and clients for additional inputs
• Maintain accurate medical evaluation records
• Stay updated with medical and regulatory developments
• Contribute to training and knowledge sharing.
• Reviewing and processing pre-authorization requests for cashless hospitalization, ensuring all necessary documentation is in order.
• Analyzing medical records and reports to verify the legitimacy of claims and assess the need for further investigation.
• Interacting with hospitals, insurance companies, and patients to address queries, resolve discrepancies, and facilitate claim approvals.
• Maintaining accurate records of all claim-related interactions and ensuring proper documentation for both cashless and reimbursement claims.
• Ensuring adherence to established guidelines, policies, and regulations related health insurance claim processing.

Strong written and verbal communication skills, with flexibility to work rotational shifts.

Kindly share your CV on email id - [email protected] with cc - [email protected] or contact - 8976760162/8828106380

Roshni Rajbhar,

HR Team,

[email protected]

8976760162

Job Types: Permanent, Fresher

Pay: ₹25,000.00 - ₹30,000.00 per month

Benefits:

• Provident Fund

Work Location: In person