Medical Officer

Family Health Plan (FHPL); Mumbai; On-site; INR 450,000 - 750,000; Full time

Job summary

Family Health Plan (FHPL) invites a claims examiner to scrutinize claims per a detailed checklist and coordinate with the CRM team to obtain and document benefit plans. The role involves communicating with investigators, guiding the investigation team on CDRF and surveyor cases, resolving critical issues with CRM, and exercising final authority on claim status.

The successful candidate will bring clinical qualifications such as BHMS/BAMS/BUMS or BDS/PharmD and solid experience in TPAs, with a

Qualifications

• BHMS/BAMS/BUMS with medical registration is must.
• BDS/PharmD with 2+ years relevant experience in TPA required.

Responsibilities

• To scrutinize the claims as per the checklist.
• Co-ordinate with CRM team for obtaining benefit plans of corporate and ensure that the same is documented and followed.
• Correspond and communicate to the investigator by giving triggers to the investigation team regarding CDRF and surveyor cases.
• Coordinate with CRM team and help them in sorting out critical issues and in settlement of priority claims.
• Final authority to decide on the status of claim.

Education

BHMS/BAMS/BUMS with medical registration

BDS/PharmD with 2+ years relevant experience in TPA

Job description

Role & responsibilities

• To scrutinize the claims as per the checklist.
• Co-ordinate with CRM team for obtaining benefit plans of corporate and ensure that the same is documented and followed.
• Correspond and communicate to the investigator by giving triggers to the investigation team regarding CDRF and surveyor cases.
• Coordinate with CRM team and help them in sorting out critical issues and in settlement of priority claims.
• Final authority to decide on the status of claim.

Preferred candidate profile

BHMS/BAMS/BUMS with medical registration is must

BDS/PharmD with 2+ years relevant experience in TPA required