Medical Operations Executive

HCL Healthcare; Dadri; On-site; INR 420,000 - 700,000; Full time

Job summary

HCL Healthcare is seeking an experienced Medical Operations professional in Uttar Pradesh to review OPD claims and reimbursements before processing. The role covers OPD claims processing, billing coordination with providers, and ensuring accurate submissions.

You will conduct UAT on the new OPD platform, provide feedback on claim logic and workflows, and support regulatory compliance. The ideal candidate has 2–7 years in medical operations, a BAMS/BNYS degree, and strong analytical skills to

Qualifications

• 2-7 years of experience in medical operations or related field (claims adjudication, cashless settlement).
• BAMS/BNYS degree from a recognized institution (any specialization).
• Strong understanding of insurance claim processes, regulations, and industry standards.
• Excellent analytical skills with ability to interpret complex data sets.

Responsibilities

• To review all OPD claims and reimbursements before being considered for further processing.
• Manage medical operations, including OPD claims processing and insurance claims handling.
• Coordinate with healthcare providers to resolve billing issues and ensure accurate claims submission.
• To conduct UAT of the newly developed OPD platform and providing feedback on claim logic, workflows and overall functionality.

Skills

Analytical skills

Insurance claims

Data interpretation

Medical operations

Education

BAMS/BNYS degree

Job description

Roles and Responsibilities

• To review all OPD claims and reimbursements before being considered for further processing.
• Manage medical operations, including OPD claims processing and insurance claims handling.
• Coordinate with healthcare providers to resolve billing issues and ensure accurate claims submission.
• To conduct UAT of the newly developed OPD platform and providing feedback on claim logic, workflows and overall functionality.

Desired Candidate Profile

• 2-7 years of experience in medical operations or related field (claims adjudication, cashless settlement).
  
• BAMS/BNYS degree from a recognized institution (any specialization).
  
• Strong understanding of insurance claim processes, regulations, and industry standards.
  
• Excellent analytical skills with ability to interpret complex data sets.