Medical Officer - TPA

Drlogy Technologies Pvt. Ltd.; New Delhi; In loco; INR 600.000 - 900.000; Tempo pieno

Descrizione del lavoro

ISIC Multispeciality Hospital in New Delhi is seeking a Medical Officer - TPA with 1–3 years of experience. You will review medical records for insurance preauthorization and claims, assess medical necessity, and coordinate with treating doctors and insurance teams to ensure compliant, accurate claim decisions.

The role requires MBBS and a focus on confidentiality, clinical accuracy, and policy adherence. Office-based position in New Delhi with a strong emphasis on process compliance and patient

Competenze

• MBBS degree and eligibility for medical practice.
• 1–3 years of relevant experience in medical administration or insurance coordination.

Mansioni

• Review medical records for insurance preauthorization and claims.
• Assess clinical information against policy criteria.
• Evaluate medical necessity of treatments and procedures.
• Coordinate with physicians and insurance teams to facilitate claims.
• Maintain confidentiality and comply with policies.
• Identify missing information and escalate complex cases.
• Document reviews and decisions accurately.
• Support preauthorization, extension, and discharge processes.
• Assist in audits and quality reviews.
• Ensure professional assessment of medical information.

Conoscenze

TPA

Insurance Claim Processing

Pre-authorisation

Medical Record Review

Cashless Coordination

Formazione

MBBS

Descrizione del lavoro

Free to Apply Verified Employer Secure & Private No Hidden Charges

Job Requirements

Experience

1 - 3 Years Experience

Education

• MBBS

All Gender

Vacancy

1

Last Date to Apply

28, April 2027

Job Role

Work Location

ISIC Multispeciality Hospital, IAA Colony, Sector C, Vasant Kunj, New Delhi

Work Mode

Work From Office

Department

IP Billing , Insurance

Role

Medical Officer - TPA

Employment type

• Full time

Key Skills

TPA

Insurance Claim Processing

Pre-authorisation

Medical Record Review

Cashless Coordination.

Preference Languages

Any Language

Job Story

Job Description

The Medical Officer – TPA reviews medical records and treatment details associated with insurance and Third-Party Administrator claims. The involves assessing medical necessity, reviewing diagnoses and treatment plans, verifying clinical documentation, and supporting preauthorization and claim processing. The Medical Officer coordinates with treating doctors, insurance teams, and TPA representatives to facilitate appropriate claim decisions while ensuring confidentiality, clinical accuracy, and compliance with applicable policies and guidelines.

• Review medical records submitted for insurance preauthorization and claims.
• Assess clinical information against applicable medical and policy criteria.
• Evaluate the medical necessity of proposed treatments and procedures.
• Review diagnoses, investigations, treatment plans, and discharge summaries.
• Verify completeness and consistency of clinical documentation.
• Coordinate with treating physicians to obtain clarifications when required.
• Review inpatient and outpatient claims according to assigned responsibilities.
• Support preauthorization, extension, and discharge approval processes.
• Identify missing information, inconsistencies, or documentation gaps.
• Provide clinical inputs to authorized insurance or TPA teams.
• Review claims for medical appropriateness within the assigned authority.
• Escalate complex or disputed cases to the designated medical reviewer.
• Maintain accurate records of reviews and decisions.
• Communicate with hospital billing and insurance coordination teams.
• Support timely resolution of claim queries and documentation requests.
• Follow applicable insurance policies, contractual requirements, and procedures.
• Maintain confidentiality of patient health and insurance information.
• Identify recurring claim issues and suggest process improvements.
• Participate in audits and quality reviews when assigned.
• Ensure professional and objective assessment of medical information.

Similar Jobs at ISIC Multispeciality Hospital

ISIC Multispeciality Hospital, located in Vasant Kunj, New Delhi, is a tertiary healthcare institution known for its expertise in spine care, orthopaedics, spinal cord injuries, and rehabilitation. The hospital has expanded its services to include multiple medical and surgical specialties, combining advanced medical technology, experienced specialists, and patient-centred care to support patients throughout diagnosis, treatment, and recovery.

ISIC HealthCare+1

Our Story

Founded by Major H. P. S. Ahluwalia, ISIC was established with a vision of providing advanced treatment and rehabilitation for people affected by spinal injuries. Over time, the institution developed from a specialised spinal injuries centre into a multispeciality hospital, retaining its focus on spine and orthopaedic care while expanding into other clinical disciplines. Its approach combines medical expertise, innovation, rehabilitation, education, and research.

ISIC HealthCare+1

Our Mission

To restore hope and joy in every patient's heart through clinical excellence, compassionate service, and high-quality medical care.

ISIC HealthCare

Our Vision

To maintain leadership in spine and orthopaedic care while becoming a preferred multispeciality healthcare provider in India.

ISIC HealthCare

Our Medical Services and Specialties

ISIC Multispeciality Hospital provides a wide range of healthcare services through specialised departments and centres of excellence, including:

• Spine Services: Evaluation and treatment of spinal disorders, spinal injuries, deformities, and related conditions.
• Orthopaedics: Medical and surgical care for bone, joint, and musculoskeletal conditions.
• Cardiac Sciences: Diagnosis and treatment of heart-related conditions.
• Neurosciences: Care for neurological disorders and conditions affecting the brain, nerves, and nervous system.
• Gastro Sciences: Diagnosis and management of digestive system disorders.
• Renal Sciences and Nephrology: Care for kidney-related conditions.
• General and Minimally Invasive Surgery: Surgical management of a variety of medical conditions.
• Critical Care: Specialised monitoring and treatment for critically ill patients.
• Onco Sciences: Cancer-related evaluation and treatment services.
• Physical Medicine and Rehabilitation: Rehabilitation support to improve mobility, function, and independence.
• Other Specialties: Dermatology, ENT, dental sciences, ophthalmology, pulmonology, urology, rheumatology, gynaecological surgery, pain management, psychology, and sports injury care.

Infrastructure and Facilities

The hospital provides modern clinical infrastructure to support diagnosis, surgery, emergency treatment, and inpatient care. Its listed facilities include:

• Approximately 200 operational beds.
• Eight operation theatres.
• A 24-hour emergency department.
• Intensive care and critical care facilities.
• In-house diagnostic services, including advanced imaging.
• Blood bank services.
• Rehabilitation services and multidisciplinary clinical support.

These facilities support the hospital's multispeciality care model and its focus on managing complex medical and surgical conditions.

ISIC Multispeciality Hospital+2

Our Medical Team

ISIC brings together specialists across spine care, orthopaedics, neurosciences, cardiac sciences, gastroenterology, renal care, critical care, and other medical disciplines. The hospital also supports academic training and professional development through postgraduate medical programmes, fellowships, and research activities.

ISIC HealthCare+2

Research, Education and Rehabilitation

ISIC supports medical education and clinical research, particularly in spinal cord injury, rehabilitation medicine, neuro-urology, and related clinical fields. Its academic activities aim to connect clinical practice with research and professional training, while rehabilitation services help patients work towards improved function and quality of life.

ISIC HealthCare+1

Why Choose ISIC Multispeciality Hospital?

• Established expertise in spine and orthopaedic care.
• Access to multiple medical and surgical specialties.
• Advanced diagnostic and surgical infrastructure.
• Emergency and critical care services.
• Rehabilitation support for patients with spinal injuries and other conditions.
• Medical education, fellowship, and research programmes.
• Services for domestic and international patients.
• A patient-centred approach focused on clinical excellence and compassionate care. ISIC, New Delhi+2

Our Commitment

ISIC Multispeciality Hospital is committed to providing integrated healthcare that combines clinical expertise, modern technology, research, and rehabilitation. By bringing multiple specialties together, the hospital aims to support patients from initial assessment through treatment and recovery while promoting compassionate care and improved health outcomes.