About Plum
Plum is an employee insurance and health perks platform focused on making health insurance simple, accessible and inclusive for modern organizations.

Healthcare in India is seeing a phenomenal shift with inflation in healthcare costs 3x that of general inflation. A majority of Indians are unable to afford health insurance on their own; and so as many as 600mn Indians will likely have to depend on employer-sponsored insurance.

Plum is on a mission to provide the highest quality insurance and healthcare to 10 million lives by FY2030, through companies that care. Plum is backed by Tiger Global and Peak XV Partners.

About the role
We are seeking qualified medical professionals to join our team as Medical Evaluation Specialist. The ideal candidate will leverage their medical expertise to critically review health insurance claim decisions, ensuring accuracy, adherence to medical protocols, and fair assessment of medical conditions. This role plays a vital part in safeguarding the integrity of medical claims,



ensuring that patient care and appropriate medical practices are at the forefront of decision-making.

Role Responsibilities
- Comprehensive Claim Reviews: Conduct thorough evaluations of health insurance claim decisions, ensuring compliance with medical protocols and standards for the rejected claims
- Decision correction: Take up rejected claims post review with Insurance companies or Third Party Administrator (TPA) doctors/adjudicators for reconsideration/corrections by building a case file with medical rationale/ medical protocols, proofs from treating doctors etc.
- Documentation Analysis: Analyze claim medical documentation in detail against policy terms and conditions to establish the validity of claims.
- Error Identification: Identify and document potential assessment errors, procedural gaps, and misinterpretations of medical evidence that may affect claim outcomes.
- Dispute Reporting: Prepare detailed and well-structured dispute reports for

📌 Medical Evaluation Specialist (Bengaluru)
🏢 Plum Benefits
📍 Bengaluru