Assistant Manager, Medical Claims Doctor – Adjudication

Szabist Isb; Karachi Division; On-site; PKR 90,000 - 130,000; Full time

Job summary

EFU Life Assurance Ltd. seeks an Assistant Manager - Claims Doctor to join the medical claims team. The ideal candidate holds an MBBS and has at least two years' experience in medical claims or insurance.

Requires deep knowledge of medical terminology, ICD-10 coding, and clinical documentation review to evaluate claims accurately. Must work independently with strong analytical and decision-making skills and collaborate with internal departments to comply with policies and standards.

Qualifications

• MBBS qualification with at least two years' experience in medical claims or insurance.
• Expertise in medical terminology, ICD-10 coding, and reviewing clinical documentation.
• Ability to work independently with strong analytical and decision-making skills.
• Collaborate with internal departments to support claims adjudication and compliance.

Responsibilities

• Review and analyze medical claims to verify accuracy against policy terms.
• Assess clinical documentation and ICD-10 coding for compliance with standards.
• Evaluate medical necessity and appropriateness of claimed treatments.
• Interpret medical terminology and clinical reports for accurate reviews.
• Collaborate with claims teams to clarify medical information and resolve discrepancies.
• Provide expert advice on complex medical claims issues and improve processes.
• Ensure assessments are thorough and completed within timeframes.
• Maintain up-to-date knowledge of coding standards and policies.
• Prepare detailed reports and documentation related to claims assessments.

Skills

Medical terminology

Medical coding

Clinical documentation review

Analytical skills

Decision-making

Education

MBBS

Tools

ICD-10 coding

Job description

EFU Life Assurance Ltd. seeks an Assistant Manager - Claims Doctor to join the medical claims team. The ideal candidate holds an MBBS and has at least two years' experience in medical claims or insurance.

Requires deep knowledge of medical terminology, ICD-10 coding, and clinical documentation review to evaluate claims accurately. Must work independently with strong analytical and decision-making skills and collaborate with internal departments to comply with policies and standards.