Paramount Healthcare Management Pvt Ltd

Key Responsibilities: Medical Claims Review: Analyze and assess pre-authorization and post-treatment reimbursement claims. Review medical records, diagnosis, investigation reports, and treatment plans to ensure clinical appropriateness and policy alignment. Validate claims based on insurance policies, internal guidelines. Decision Making: Determine the admissibility or rejection of claims and recommend the claim amount. Coordinate with claims team and finance for timely claim settlements. Communication & Coordination: Liaise with hospitals, policyholders, and internal teams to clarify documentation or medical details. Provide medical inputs to customer support or grievance redressal teams when needed. Documentation & Reporting: Maintain accurate and updated documentation of all reviewed cases. Support audit and compliance processes by ensuring claims are processed with proper medical justification. Quality & Compliance: Ensure adherence to TATs (Turn Around Times) and SLAs (Service Level Agreements). Maintain confidentiality and handle sensitive health data in compliance with data protection regulations. Required Qualifications & Experience: Education: MBBS / BAMS / BHMS / BDS (depending on organizational policy) Experience: 1–5 years in health insurance, TPA, or hospital claims processing preferred. Licenses: Valid medical registration with relevant council. Skills & Competencies: Strong understanding of medical terminology, clinical procedures, and healthcare systems. Knowledge of health insurance policies, ICD/CPT coding, and regulatory norms (IRDAI). Analytical thinking and attention to detail. Good written and verbal communication skills. Proficiency in MS Office and claims processing software. Job Type: Full-time Pay: ₹80,000.00 - ₹100,000.00 per month Work Location: In person