Job Description – Medical Claim Investigation Executive
Position: Medical Claim Investigation Executive
Qualification: B.Pharm / B.Sc. Nursing / GNM
Job Type: Non-Clinical
Industry: Health Insurance / Medical Claim Investigation
Location: Aliganj, Lucknow
About the Role
We are looking for B.Pharm and Nursing professionals to join our medical claim investigation team. This is a non-clinical role where candidates will use their medical knowledge to verify and assess healthcare-related information for insurance claims.
Key Responsibilities
- Review and verify medical documents, prescriptions, investigation reports, bills, and hospital records.
- Conduct medical claim-related verification as per assigned cases.
- Coordinate with hospitals, clinics, pharmacies, patients, and other relevant parties for information verification.
- Check the consistency and authenticity of medical information provided in claim documents.
- Identify discrepancies, missing information, or inconsistencies in medical records.
- Prepare clear and accurate investigation reports based on findings.
- Maintain proper documentation and case records.
- Coordinate with the internal claims/investigation team for case updates and closures.
- Maintain confidentiality of patient and claim-related information.
Eligibility
- B.Pharm / B.Sc. Nursing / GNM candidates can apply.
- Freshers with good medical knowledge are welcome.
- Experience in insurance claims, TPA, hospital administration, medical coding, or medical investigation will be an advantage.
- Good communication and documentation skills.
- Basic computer knowledge and ability to work with MS Office.
- Solid attention to detail and analytical skills.
Important
This is a non-clinical position. The role does not involve patient treatment, nursing duties, or direct clinical care.
Key Skills: Medical Documentation | Claim Verification | Healthcare Knowledge | Investigation | Report Writing | Communication | Attention to Detail