Job Title: Medical Officer – IPD (RI)
Department: Claims
Location: Bangalore White Filed

As per business requirement

Reporting To: Team Lead / Manager – Medical Services

Job Summary

The Medical Officer (IPD – RI) is responsible for reviewing inpatient (IPD) health insurance claims, evaluating medical necessity, ensuring compliance with policy terms and clinical guidelines, and supporting timely claim decisions while maintaining quality standards.

Key Responsibilities
Review and assess IPD health insurance claims.
Verify diagnosis, treatment, investigations, and medical necessity.
Scrutinize hospital records and supporting documents.
Ensure claims comply with policy terms, medical protocols, and regulatory guidelines.
Approve, query, or recommend rejection of claims based on medical findings.
Coordinate with hospitals, claims teams, and internal stakeholders for additional medical information.
Maintain turnaround time (TAT) and quality benchmarks.
Document claim decisions accurately in the claims management system.
Support audits, quality checks, and process improvement initiatives.
Stay updated with medical advancements, treatment protocols, and insurance guidelines.

Eligibility




BAMS/BHMS/BDS (as per company policy).
Valid registration with the respective medical council (where applicable).

Experience
0–3 years of experience in health insurance, TPA, or hospital claims.
Freshers with good clinical knowledge may also be considered.

Required Skills
Robust clinical and medical knowledge.
Understanding of IPD claim adjudication processes.
Knowledge of health insurance and TPA operations.
Positive analytical and decision-making skills.
Excellent communication and documentation abilities.
Proficiency in MS Office and claims processing systems.
Ability to work under defined TATs and quality parameters.

Key Competencies
Attention to detail
Clinical judgment
Analytical thinking
Teamwork
Time management
Customer focus
Integrity and confidentiality

Job Type: Full time

Pay: ₹28,000.00 - ₹35,000.00 per month

Benefits:
Health insurance
Leave encashment
Life insurance
Provident Fund

Education:
Bachelor's (Preferred)

Experience:
total work: 1 year (Preferred)

Work Location: In person

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