Assistant Manager - Claims Rx Consultants

5 - 10 years

8 - 15 Lacs

Mumbai

Work from Office

Experienced and licensed medical professional (MBBS/MD) with a strong background in medical claims assessment and clinical evaluation within the health insurance or TPA industry. Skilled in reviewing pre-authorization requests, hospitalization claims, and medical documentation to ensure medical necessity, policy compliance, and regulatory standards (IRDAI). Proficient in ICD-10 coding, claims adjudication, and fraud detection, with a focus on accuracy, ethical judgment, and collaborative decision-making. Adept at coordinating with hospitals, TPAs, and internal teams to streamline claim processing and maintain service quality.

Posted 4 months ago

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