Medical Policy Scheme Advisor This job is for someone who has medical knowledge and has worked with government health schemes like RGHS The company wants someone who understands how these schemes work how claims are processed and can guide the team on the right rules and processes Location Timing Location Bhopal For 3 months and after that you will shift to Jaipur s office Work from office Timings Monday to Saturday 10 00 AM to 6 00 PM Job Type Full time Responsibilities Guide on government schemes You ll be the go-to person for anything related to schemes like RGHS MAA Yojana and PMJAY - how they work what s covered what procedures are allowed and how to use them correctly Mapping codes These schemes have different packages and codes You ll match them so everything stays in sync and the system works smoothly Create rules and protocols You ll help prepare internal documents and rules based on Standard Treatment Guidelines STGs - this is like a fixed way of treating certain conditions Help with medical codes You should know coding systems like ICD and SNOMED - these are used in medical records and claims Handle complex queries If there is any confusion or technical issue related to schemes or claims you ll help solve it Support claims process You ll help improve how claims are processed for these schemes making sure they are done properly and quickly Stay updated Government health schemes change from time to time - you need to keep yourself updated and help the team stay informed Training the team You may also create training material or help explain things to your internal team Who can apply Eligibility You must have a medical degree like MBBS BAMS BHMS BUMS or You have worked on a TPA desk desk where claim processing is done with good clinical understanding Minimum 3 years of experience with government health schemes like RGHS PMJAY etc You must know how claims work what documents are needed and how they are approved or rejected You should understand medical codes like ICD-10 SNOMED CT You should know how to compare and work with different scheme benefit packages You should know how to create medical rules based on standard guidelines If you know how TPAs Third Party Administrators work and how claims are managed that s a big plus Extra skills that are nice to have Not compulsory Certification in healthcare management Experience with digital healthcare platforms or IT systems Good at problem-solving and communication Can work alone or in remote settings If you ve done medical audits that s an extra advantage In Short The company wants a female candidate who understands medical treatment government health schemes and claims processing You will act as an expert who guides the company solves problems builds internal rules and supports the team with your knowledge Job Types Full-time Permanent Pay 25 000 00 - 45 000 00 per month Job Type Full-time Pay 25 000 00 - 45 000 00 per month Benefits Health insurance Provident Fund Schedule Day shift Supplemental Pay Performance bonus Yearly bonus Experience RGHS Medical policy advisor 1 year Required Work Location In person

📌 Medical Policy And Claim Advisor (Rajasthan)
🏢 Hyrmus
📍 Rajasthan