Medical Officer (Non Clinical Role)

Medi Assist; Mumbai; On-site; INR 450,000 - 700,000; Full time

Job summary

Medi Assist is seeking Medical Officers to review and process health insurance claims using medical knowledge and policy guidelines. This office-based role requires evaluating admissibility, scrutinizing documents, and ensuring timely, accurate decisions.

Responsibilities include verifying ICD codes, room rent limits, and package charges, coordinating with internal teams, and handling inquiries. Freshers to 3 years' experience in healthcare or insurance are welcome to apply.

Qualifications

• BAMS, BHMS, MBBS or BSc Nursing with Indian registration.
• Strong analytical and decision-making abilities.
• Good communication and computer proficiency.
• Freshers or up to 3 years' experience in healthcare, hospitals, insurance, or TPA.

Responsibilities

• Assess medical claims and verify diagnosis, treatment details, and admissibility.
• Review claims per policy terms and conditions.
• Evaluate ICD coding, co-payments, non-medical expenses, room rent limits, and package charges.
• Verify supporting documents and raise requirements for incomplete cases.
• Coordinate with internal teams for clarifications and escalations.
• Approve or deny claims within defined turnaround times (TAT).
• Handle claim-related queries and email communications.

Skills

Analytical skills

Decision making

Communication skills

Computer proficiency

Education

BAMS

BHMS

MBBS (Indian Registration Mandatory)

BSc Nursing

Job description

Medical Officer / Consultant (Work From Office Only)

Location: Mumbai / Bangalore

Experience: 0 to 3 Years

Qualification: BAMS / BHMS / MBBS (Indian Registration Mandatory)/ BSc Nursing

We are looking for Medical Officers to review and process health insurance claims by applying medical knowledge and policy guidelines. The role involves evaluating medical admissibility, scrutinizing claim documents, and ensuring timely and accurate claim decisions.

Key Responsibilities:

• Assess medical claims and verify diagnosis, treatment details, and admissibility.
• Review claims as per insurance policy terms and conditions.
• Evaluate ICD coding, co-payments, non-medical expenses, room rent limits, and package charges.
• Verify supporting documents and raise requirements for incomplete cases.
• Coordinate with internal teams for claim-related clarifications and escalations.
• Approve or deny claims within defined turnaround times (TAT).
• Handle claim-related queries and email communications.

Desired Candidate Profile:

• BAMS, BHMS, or BSc Nursing
• Strong analytical and decision-making skills.
• Good communication and computer proficiency.
• Freshers and candidates with up to 3 years of experience in Healthcare, Hospitals, Insurance, or TPA industry may apply.