Medical Officer
🏥 Hospital: Medi Assist
📍 Location: Bangalore Urban,Mumbai, Maharashtra
👨 Employment Type: Full Time
💰 Salary: Not Disclosed
📧 Contact Email:
muskan.abdul@mediassist.in
📞 Contact Phone:
7204999484
💼 Experience:
0-3 Years
🕒 Employment Type:
Full Time
🏷️ Job Category:
Hospital Support Staff
We are looking for a detail-oriented and analytical medical officer (non-clinical) to support the medical review and processing of health insurance claims.
- The successful candidate will be responsible for evaluating medical records, verifying diagnoses, reviewing treatment details, and assessing claim admissibility in accordance with insurance policy guidelines.
- The role involves scrutinizing medical documentation, interpreting ICD coding, reviewing package charges, room rent eligibility, co-payments, and non-medical expenses while ensuring timely and accurate claim decisions.
- The medical officer will coordinate with internal teams to resolve claim-related queries, maintain accurate documentation, and ensure compliance with regulatory standards, company policies, and defined turnaround times.
- The ideal candidate should possess strong medical knowledge, analytical thinking, attention to detail, and excellent communication skills.
Roles & Responsibilites
- Review and evaluate health insurance claims using medical knowledge and policy guidelines.
- Verify diagnoses, treatment plans, medical records, and supporting clinical documentation.
- Assess claim admissibility in accordance with insurance terms, conditions, and regulatory requirements.
- Review ICD coding, package charges, room rent eligibility, co-payments, and non-medical expenses.
- Identify incomplete documentation and raise requests for additional information when required.
- Approve, reject, or recommend claims within defined turnaround times (TAT).
- Coordinate with internal teams and stakeholders to resolve claim-related queries and escalations.
- Maintain accurate documentation of claim reviews and medical decisions.
- Ensure compliance with company policies, insurance regulations, and quality standards.
- Respond to claim-related email communications professionally and promptly.
- Participate in quality audits, process improvement initiatives, and ongoing training programs.
- Maintain confidentiality of medical records and adhere to ethical and professional standards.
