Role & responsibilities The Medical Officer will be responsible for evaluating, scrutinizing, and processing health insurance claims and cashless pre-authorization requests. The primary focus is to ensure medical admissibility, verify standard line-of-treatment protocols, check compliance with policy terms and conditions, and maintain strictly monitored Turnaround Times (TAT).

- HealthIndia Insurance TPA Services Pvt. Ltd.

Department: Claims Department.

Main responsibilities and Opportunities

• Medical Scrutiny.

- Provide Medical opinion for Health Insurance Claims.
- Processing ... HealthIndia Insurance TPA Services Pvt. Ltd.

- HealthIndia Insurance TPA Services Pvt. Ltd. “• Proficient with medical terms & system.

- Understanding of Policy terms & conditions & Various Protocols / Guidelines.
- Understanding of Claims adjudication ...”

Key Responsibilities & Job Duties

1.



Pre-Authorization & Cashless Approval (PA Desk)

- Scrutinize incoming pre-authorization requests from empaneled network hospitals within defined TAT guidelines.
- Evaluate provisional diagnoses, proposed treatment plans, and estimated costs against established medical guidelines. Indeed
- Issue initial approval, request necessary clinical clarification/deficiency documents, or deny requests based on policy terms. HealthIndia Insurance TPA Services Pvt. Ltd.

1. Investigation & Fraud Mitigation

- Flag suspected exaggerated billing, unbundling of procedures, unnecessary hospitalizations, or fraudulent claims for further field investigation.
- Coordinate with audit and provider-network teams to report erroneous billing practices by hospitals. Indeed

📌 Walk-in || Medical Officer (Chennai)
🏢 Medi Assist
📍 Chennai