Job description – Claims processors – IPD/OPD
Job Purpose
To review and adjudicate inpatient reimbursement claims by validating medical documentation, policy terms, and insurer protocols, ensuring accurate, timely, and compliant claim processing.
Principal Accountabilities
- Process inpatient reimbursement claims accurately and within TAT as per insurer and organizational guidelines.
- Review and validate medical documents (diagnoses, procedures, discharge summaries) against policy and coding standards.
- Escalate complex or out-of-limit cases to the Team Manager/Medical Specialist for timely resolution.
- Ensure compliance with regulatory, insurer, and organizational requirements while maintaining audit-ready records.
- Coordinate with hospitals for clarifications and support managers in resolving insurer or customer queries.

Reporting Structure:
Reports To: Floor Manager – Claims
Major Challenges
- Managing high claim volumes while maintaining TAT and accuracy.
- Interpreting diverse insurer policies consistently.
- Balancing quick turnaround with thorough document scrutiny.




- Coordinating with hospitals and internal stakeholders under strict deadlines.

Decisions
- Independent: Adjudication of standard pre-authorization cases as per policy terms.
- With Approval: Escalations requiring specialist opinion, insurer concurrence, or deviations from package norms.

Interactions
Internal: Claims team, Case Management, CRM team.
External:
- Hospitals through Query (for discharge summaries, clarifications, and missing documents).
- Insurers (for concurrence and escalations).

Qualifications & Experience
- Education: Graduates -BHMS/BAMS/BDS
- Experience:
- Fresher medical graduates can apply.
- Prior experience in Pre-Authorization / Claims management in a TPA or HealthTech setup preferred.
- Exposure to authorization or reimbursement processes is an added advantage.
- Team Lead: 3+ years of experience in the same domain.

Other requirements:
- Robust medical knowledge w

📌 Claims - Medical Officer - 10 August 2026 (Chennai)
🏢 Vidal Health Insurance TPA
📍 Chennai