About Us: VH Medcare Private Limited (VHM) is a specialized, healthcare management company focused on transforming how organizations deliver healthcare perks to their employees. By eliminating the traditional dependency on insurers, VHM enables corporates to directly manage healthcare programs with greater control, transparency, and efficiency. VH Medcare partners directly with employers to design and implement customized healthcare solutions tailored to workforce needs. Under this model, Vidal Health operates as a comprehensive healthcare administrator and care manager—delivering end-to-end program management that prioritizes cost optimization, quality care, and improved employee experience. Job Summary: We are seeking a dedicated and detail-oriented Medical Officer – Claims & Pre-Authorization to ensure timely and accurate processing of pre-authorization & Claims requests. The role involves maintaining strict turnaround times, achieving high productivity targets, ensuring quality compliance, and effectively managing escalations. The candidate will play a critical role in delivering seamless claims adjudication while maintaining clinical accuracy and customer satisfaction. Key Responsibilities: • Pre-Authorization Processing (TAT): Review and process pre-authorization requests within a turnaround time of 1 hour, ensuring timely decision-making. • Productivity Management:



Process a minimum of 50 claims per day (approx. 1100 claims per month) while maintaining accuracy and efficiency. • Quality Assurance: Conduct daily quality audits (minimum 2 cases per day) to ensure adherence to clinical and operational guidelines. • Error-Free Processing: Maintain 99% accuracy in pre-authorization and claims processing by following defined protocols and documentation standards. • Escalation Management: Address and resolve escalations received via email and customer care teams within 24 hours. • Clinical Evaluation: Assess medical necessity, treatment plans, and policy coverage for claims adjudication. • Compliance & Documentation: Ensure all decisions are compliant with internal policies, clinical guidelines, and regulatory requirements. • Coordination & Support: Work closely with claims, operations, and hospital teams for smooth case handling and resolution. • Continuous Improvement: Identify process gaps and contribute to improving turnaround time, accuracy, and service quality. Qualifications: • MBBS / BAMS / BHMS/BDS or equivalent medical qualification • Fresher-2 years of experience in claims / pre-authorization / healthcare operations (TPA or insurance preferred) • Strong understanding of medical terminology, treatment protocols, and insurance processes

📌 Medical Officer_SF_2 (Karnataka)
🏢 VH Medcare
📍 Karnataka