Medical Officer

FHPL - Family Health Plan Insurance TPA Limited; Hyderabad; On-site; INR 800,000 - 1,400,000; Full time

Job summary

FHPL – Family Health Plan Insurance TPA Limited in Hyderabad seeks a Medical Officer for on-site engagement. You will review medical documents and health insurance claims to ensure medical necessity and policy alignment, working with physicians, hospitals, and internal teams to clarify information and inform approvals.

You will contribute to clinical quality standards, participate in audits, and aid in developing medical protocols and wellness initiatives, ensuring timely, ethical medical

Qualifications

• Strong clinical knowledge with practical medicine experience and ability to interpret medical records using evidence-based guidelines.
• Experience in training internal teams on medical and claims topics is a plus.
• Excellent communication and documentation skills; ethical judgment and attention to detail in medical reviews.

Responsibilities

• Review and evaluate medical documents and health insurance claims for medical necessity and policy alignment.
• Coordinate with physicians, hospitals, and internal teams to clarify medical information and support decisions on approvals, rejections, and pre-authorizations.
• Provide medical opinions and contribute to clinical quality standards and internal audits.
• Assist in developing medical protocols, training materials, and wellness programs.
• Respond to medical queries and support grievance resolution to enhance member experience.
• Support continuous improvement of medical reviews and compliance with standards.

Skills

Clinical knowledge

Documentation

Medical ethics

Communication

Training experience

Education

MBBS

BHMS

BUMS

BAMS

Tools

Claims software

Job description

Company Description

FHPL – Family Health Plan Insurance TPA Limited (FHPL), incorporated in 1995 and licensed by IRDAI in 2002, is a leading Third Party Administrator in the health insurance ecosystem. With its registered office in Chennai and corporate office in Hyderabad, FHPL manages health insurance claims for individual, corporate, and government health schemes across India. The organization is the first licensed TPA in India to be certified against ISO/IEC 27001:2013 for Information Security Management System and also holds ISO 9001:2015 certification for Quality Management. Guided by a philosophy of standing behind and going beyond insurance, FHPL focuses on quality services, industry-leading standards, and wellness-oriented solutions. The company offers a seamless experience to stakeholders across the healthcare and insurance sectors and continues to build its reputation as a wellness leader.

Role Description

The Medical Officer role is a full-time, on-site position based at FHPL’s corporate office in Hyderabad. The Medical Officer will review and evaluate medical documents and health insurance claims, ensuring medical necessity, adherence to clinical guidelines, and alignment with policy terms. Daily responsibilities include coordinating with physicians, hospitals, and internal teams to clarify medical information, provide medical opinions, and support decision-making on approvals, rejections, and pre-authorizations. The role also involves contributing to clinical quality standards, participating in internal audits, and assisting in the development of medical protocols, training materials, and wellness programs. The Medical Officer will respond to medical queries, support grievance resolution, and help enhance member experience through accurate, timely, and ethical medical assessments.

Qualifications

• Candidates should possess strong clinical knowledge and practical experience in Medicine, with the ability to interpret medical records and apply evidence-based guidelines.
• Candidates should possess relevant Training experience or a willingness to conduct and participate in training programs for internal teams on medical and claims-related topics.
• Candidates should possess excellent communication and documentation skills, strong ethical judgment, and attention to detail in medical and claims review.
• BHMS/BUMS/BAMS/MBBS or equivalent recognized medical degree is required; additional qualifications in hospital administration, insurance TPA, are an advantage.
• Experience in health insurance, TPAs, utilization review, or clinical audit roles is preferred, along with basic proficiency in using medical and claims management software.