Medical Officer

Job description URGENT OPENING FOR MEDICAL OFFICER Workings Hours: 9 Hrs Work Mode : Office Key Responsibilities: Review and assess medical claims submitted by corporate clients against policy terms and medical guidelines. Analyze clinical documents such as medical reports, diagnostic tests, prescriptions, discharge summaries, and other relevant medical records. Verify the authenticity, appropriateness, and completeness of medical documentation related to claims. Provide medical expertise to determine the validity and admissibility of claims. Collaborate with claims processing and underwriting teams to resolve discrepancies or clarifications related to medical information. Identify potential fraud, over-utilization, or discrepancies in claims through thorough medical evaluation. Maintain up-to-date knowledge of medical terminologies, treatment protocols, and emerging health trends relevant to claims assessment. Assist in developing and updating medical claim processing guidelines and protocols. Support training and capacity-building activities for claims staff on medical aspects of claims. Ensure compliance with regulatory and company policies during claims assessment. Communicate effectively with healthcare providers, corporate clients, and internal teams to clarify medical information as needed. Generate detailed reports and documentation on claim assessments and decisions. Qualification: BHMS, BMS