Job Description

nJob Overview:
nWe are seeking a qualified and experienced Medical Officer (Doctor) to join our team at Policybazaar for Business. This role involves using medical expertise to assist in evaluating insurance claims, conducting risk analysis, and ensuring that the medical aspects of claims are handled in accordance with industry standards and regulations. The ideal candidate will have a robust background in healthcare and an understanding of insurance policies and risk management in the medical field.
n

nKey Responsibilities:
nClaims Review and Evaluation:
n• Review medical claims submitted by policyholders to ensure accuracy and compliance with
ninsurance policies.
n• Analyze the medical documentation provided by hospitals, clinics, and other healthcare
nproviders to determine the legitimacy of claims.
n• Assess the medical necessity of procedures, treatments, and hospital admissions as per the
ninsurance policy guidelines.
n• Provide second opinion or consultation on disputed claims or complex medical cases.
n

nMedical Advisory Services:




n• Provide expert advice and medical guidance to the TPA team, insurance providers, and
npolicyholders regarding medical treatment, diagnoses, and claims.
n• Act as a liaison between healthcare providers and the insurance company to ensure a
nseamless claims process and accurate policyholder information.
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nMedical Audits and Reports:
n• Conduct medical audits to ensure the accuracy of claims and prevent fraud.
n• Prepare detailed reports regarding the medical aspects of claims, risk assessments, and
npolicy compliance for senior management and insurers.
n

nCollaboration with Medical Providers:
n• Communicate with healthcare providers, hospitals, and clinics to clarify medical information
nand ensure proper documentation is available for claims processing.
n• Collaborate with medical professionals in cases of complex treatments or potential
ndiscrepancies between claimed and provide

📌 Medical Officer (Gurugram)
🏢 Policybazaar For Business
📍 Gurugram