Clinical Intelligence Specialist

Zeomega Infotech; Bengaluru; On-site; INR 900,000 - 1,500,000; Full time

Job summary

Zeomega Infotech in Bengaluru (India) seeks a Clinical Intelligence Specialist to review medical coverage policies converted by GenAI and ensure alignment with the source PDFs. You will validate policy rules and facilitate accurate questionnaire formatting in ClicBank, Zeomega's content tool.

You will collaborate with product, QA, and AI teams, identify ambiguities, coding needs, and support staff training. MBBS/MD with strong English writing is required; US payer/Medicare knowledge is a plus.

Qualifications

• MBBS/MD or foreign medical graduate background with strong English writing skills and the ability to read and interpret medical policies.
• Comfort with clinical documentation and ability to explain policy rules to cross-functional teams.
• Experience researching and analyzing medical policies and identifying documentation deficiencies.

Responsibilities

• Ensure converted documents match source documents and identify discrepancies.
• Research and analyze as needed.
• Analyze medical policies and identify documentation deficiencies.
• Assign codes for each answer option in the decision tree.
• Follow coding conventions and serve as coding consultant.
• Support training and mentoring of staff.
• Handle special projects as requested.

Skills

Strong English writing

Read medical policies

Clinical documentation

Explain policy rules

Research and analysis

Education

MBBS / MD / foreign medical graduate background

Tools

Microsoft Office Suite

Job description

POSITION SUMMARY

This role involves working as a key collaborator in reviewing medical coverage policies converted by the GenAI. The Clinical Intelligence Specialist will use their clinical experience to make sure converted document matches with the medical coverage policies in PDF document. Post manual review, it is very important to make sure converted medical policies into the questionnaire format is available in Clicbank. ClicBank, is ZeOmegas proprietary tool for the content development and management.

Reasonable Accommodations Statement

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Job Responsibilities:

• This role is accountable to ensure the converted documents are matching with the source document. Identifies discrepancies, potential quality issues and correct them manually.
• Research and analyse as needed.
• Analyses the medical policies and identifies documentation deficiencies.
• Assigns codes for each answer options in the decision tree.
• Follows coding conventions. Serves as coding consultant.
• Serves as resource and subject matter expert to other coding staff.
• Assists lead or supervisor in orienting, training, and mentoring staff.
• Provides ongoing training to staff as needed.
• Handles special projects as requested.

SKILLS & ABILITIES:

• Education: MBBS / MD / foreign medical graduate background, strong English writing, ability to read medical policies, and comfort with clinical documentation.
• Product fit: Can explain policy rules to product managers, QA, engineers, and AI teams; can identify ambiguity, versioning needs, auditability, and human-in-the-loop review points.

Experience:

U.S. payer exposure, Medicare Advantage, Medicaid, Commercial payer, prior authorization, appeals, UM, medical necessity, HEDIS/Stars, risk adjustment, or clinical guidelines.

Must have some experience within a clinical setting and/or as an experience includes clinical research, critical thinking, time management, medical coding.

Computer Skills:

Microsoft Office Suite - Word, Excel, PowerPoint, Visio, Teams, Sharepoint, Outlook, OneDrive, NCD , LCD.