Registration: Valid State/National Medical Council registration is mandatory
Key Responsibilities
Review and assess medical claims and related patient/hospital documents.
Verify diagnosis, treatment details, medical records, prescriptions, investigation reports, and bills.
Evaluate the medical necessity and appropriateness of treatment as per applicable guidelines and policies.
Scrutinize pre-authorization and reimbursement claims.
Identify discrepancies, missing documents, inconsistencies, or potential fraud indicators in claims.
Coordinate with hospitals and internal teams for clarification and additional medical documents.
Provide medical opinions and recommendations on claim admissibility.
Ensure timely processing of assigned claims while maintaining accuracy and quality.
Maintain proper documentation and records of claim assessments.
Follow company SOPs, medical guidelines, and applicable regulatory requirements.
Support the team in meeting defined productivity, quality, and turnaround-time (TAT) targets.
Pay: ₹20,813.87 - ₹37,171.55 per month
Work Location: Remote
📌 Medical Officer Hinoo
🏢 Vidal Health Tpa Private
📍 Hinoo
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