Medical Officer

Job description

URGENT OPENING FOR MEDICAL OFFICER

Workings Hours: 9 Hrs

Work Mode : Office

Key Responsibilities:

• Review and assess medical claims submitted by corporate clients against policy terms and medical guidelines.
• Analyze clinical documents such as medical reports, diagnostic tests, prescriptions, discharge summaries, and other relevant medical records.
• Verify the authenticity, appropriateness, and completeness of medical documentation related to claims.
• Provide medical expertise to determine the validity and admissibility of claims.
• Collaborate with claims processing and underwriting teams to resolve discrepancies or clarifications related to medical information.
• Identify potential fraud, over-utilization, or discrepancies in claims through thorough medical evaluation.
• Maintain up-to-date knowledge of medical terminologies, treatment protocols, and emerging health trends relevant to claims assessment.
• Assist in developing and updating medical claim processing guidelines and protocols.
• Support training and capacity-building activities for claims staff on medical aspects of claims.
• Ensure compliance with regulatory and company policies during claims assessment.
• Communicate effectively with healthcare providers, corporate clients, and internal teams to clarify medical information as needed.
• Generate detailed reports and documentation on claim assessments and decisions.

Qualification:

BHMS, BMS