Medical Officer

Job Title

Job Responsibility

Responsible for dealing with the customers & internal doctors over the call, Stakeholder management

Reporting Relationship to

Chief Manager - Health Management

Job Profile

• 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: Customer Calling - In Bound / Out Bound

• 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.

Education

BHMS/BAMS/BUMS/BPT/Nursing

Language must

English & Hindi fluency value add if any additional language

Preferred Experience profile

Minimum 6 years of experience in experience in Insurance Industries in Health domain.

Personality Traits

Ability to handle sensitive situations, strong interpersonal skills, eye for detail, Analytical skill

Grade

Location

Contact Person: Pramod / Chaitanya

8108014045 / 8977658984