ABOUT THE ROLE

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We are looking for a Medical Officer with strong knowledge of ECHS, CGHS, and third-party administrator (TPA) processes. This is a corporate role focused on medical claims review, pre-authorization, and insurance coordination. The ideal candidate will have 2–6 years of relevant experience and a sound understanding of health insurance operations and medical documentation standards.

KEY RESPONSIBILITIES

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Review and process health insurance claims under ECHS, CGHS, and other TPA schemes
Evaluate pre-authorization and enhancement requests with clinical correlation
Analyze discharge summaries, investigation reports, and treatment records for claim validation
Verify medical necessity and appropriateness of treatment as per policy and clinical standards
Identify documentation discrepancies and raise clinical queries with empanelled hospitals
Coordinate with hospitals, insurers, and internal teams for smooth claim processing
Ensure compliance with NHA, PMJAY, and Ayushman Bharat guidelines
Maintain accurate documentation and adhere to defined turnaround time (TAT)
Stay updated on latest insurance policies, healthcare regulations, and government scheme guidelines

REQUIRED SKILLS & QUALIFICATIONS





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Ayush or BAMS degree (registered practitioner preferred)
Minimum 2–5 years of experience in TPA, health insurance, or claims review
In-depth knowledge of ECHS, CGHS, and other TPA / insurance processes
Solid understanding of medical documentation and claims review standards
Valuable analytical ability and sound clinical judgment for claims evaluation
Accuracy and attention to detail in documentation
Effective communication and coordination skills

PREFERRED EXPERIENCE

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Prior experience in a TPA company, insurance firm, or health insurance desk
Hands-on experience with PMJAY / Ayushman Bharat claim processing
Knowledge of ECHS / CGHS empanelment norms and billing procedures
Familiarity with NHA protocols and government health scheme guidelines

BENEFITS

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Salary up to ₹8,00,000 per annum (based on experience)
Paid time off
Growth opportunity in the health insurance and TPA sector

JOB DETAILS

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Job Type: Full time
Work Location: In-Person (On-site)

Pay: Up to ₹800,000.00 per year

Benefits:
Life insurance
Paid time off

Work Location: In person

📌 Medical Officer – Tpa & Claims Review Noida
🏢 Immabeme Solutions
📍 Noida