Medical Officer – TPA Claim Process
4 weeks ago
Job Title: Medical Officer – TPA Claim Process Department: TPA / Health Insurance Desk Location: Vadodara Reporting To: TPA Manager / Operations Head Job Summary: The Medical Officer (TPA) will be responsible for reviewing, validating, and processing insurance (TPA) claims, ensuring medical accuracy, compliance with policy terms, and timely coordination between hospital departments, doctors, and TPA representatives. Key Responsibilities: Examine and verify patients’ medical records, treatment plans, and discharge summaries for insurance claim processing. Coordinate with treating consultants to obtain medical justifications or clarifications required by the TPA. Scrutinize pre-authorization and final bill submissions as per TPA and insurance guidelines. Ensure correctness of ICD codes, procedures, and diagnosis in the claim documents. Review claim queries and prepare appropriate medical responses or justifications. Liaise with TPA coordinators, hospital billing, and admission teams to ensure smooth cashless approval and reimbursement flow. Maintain accurate claim records and ensure timely submission of documents to TPAs. Monitor and track pending and rejected claims, ensuring resolution in coordination with the TPA team. Ensure compliance with TPA policies, medical ethics, and hospital protocols. Provide medical support to the TPA operations team for claim audits and reconciliation. Required Qualifications & Skills: MBBS / BHMS / BAMS / equivalent medical qualification (MCI-registered preferred). 1–3 years of experience in hospital TPA claim processing or medical audit. Sound knowledge of health insurance policies, cashless & reimbursement claim processes. Strong analytical and documentation skills. Proficiency in MS Office and hospital management software (HMS). Good communication and coordination abilities.
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Medical Officer – TPA Claim Process
3 weeks ago
Vadodara, India Nucleon Health Full timeJob Title: Medical Officer – TPA Claim ProcessDepartment: TPA / Health Insurance DeskLocation: VadodaraReporting To: TPA Manager / Operations HeadJob Summary:The Medical Officer (TPA) will be responsible for reviewing, validating, and processing insurance (TPA) claims, ensuring medical accuracy, compliance with policy terms, and timely coordination between...
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Medical Officer – TPA Claim Process
3 weeks ago
Vadodara, India Nucleon Health Full timeJob Title: Medical Officer – TPA Claim Process Department: TPA / Health Insurance Desk Location: Vadodara Reporting To: TPA Manager / Operations Head Job Summary: The Medical Officer (TPA) will be responsible for reviewing, validating, and processing insurance (TPA) claims, ensuring medical accuracy, compliance with policy terms, and timely coordination...
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Medical Officer – TPA Claim Process
3 weeks ago
Vadodara, India Nucleon Health Full timeJob Title: Medical Officer – TPA Claim Process Department: TPA / Health Insurance Desk Location: Vadodara Reporting To: TPA Manager / Operations Head Job Summary: The Medical Officer (TPA) will be responsible for reviewing, validating, and processing insurance (TPA) claims, ensuring medical accuracy, compliance with policy terms, and timely coordination...
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Medical Officer
2 weeks ago
Vadodara, India Nucleon Health Full timeJob Title: Medical Officer - TPA Claim Process Department: TPA / Health Insurance Desk Location: Vadodara Reporting To: TPA Manager / Operations Head Job Summary: The Medical Officer (TPA) will be responsible for reviewing, validating, and processing insurance (TPA) claims, ensuring medical accuracy, compliance with policy terms, and timely coordination...
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Medical Officer – TPA Claim Process
4 weeks ago
Vadodara, India Nucleon Health Full timeJob Title: Medical Officer – TPA Claim ProcessDepartment: TPA / Health Insurance DeskLocation: Vadodara Reporting To: TPA Manager / Operations HeadJob Summary:The Medical Officer (TPA) will be responsible for reviewing, validating, and processing insurance (TPA) claims, ensuring medical accuracy, compliance with policy terms, and timely coordination...
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Medical Officer – TPA Claim Process
4 weeks ago
Vadodara, India Nucleon Health Full timeJob Title: Medical Officer – TPA Claim ProcessDepartment: TPA / Health Insurance DeskLocation: Vadodara Reporting To: TPA Manager / Operations HeadJob Summary:The Medical Officer (TPA) will be responsible for reviewing, validating, and processing insurance (TPA) claims, ensuring medical accuracy, compliance with policy terms, and timely coordination...
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Medical Officer – TPA Claim Process
3 weeks ago
Vadodara, India Nucleon Health Full timeJob Title: Medical Officer – TPA Claim ProcessDepartment: TPA / Health Insurance DeskLocation: VadodaraReporting To: TPA Manager / Operations HeadJob Summary:The Medical Officer (TPA) will be responsible for reviewing, validating, and processing insurance (TPA) claims, ensuring medical accuracy, compliance with policy terms, and timely coordination between...
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Medical Officer – TPA Claim Process
4 weeks ago
Vadodara, Gujarat, India, Gujarat Nucleon Health Full timeJob Title: Medical Officer – TPA Claim ProcessDepartment: TPA / Health Insurance DeskLocation: Vadodara Reporting To: TPA Manager / Operations HeadJob Summary:The Medical Officer (TPA) will be responsible for reviewing, validating, and processing insurance (TPA) claims, ensuring medical accuracy, compliance with policy terms, and timely coordination...
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Vadodara, India Medi Assist Insurance TPA Pvt. Ltd. Full timeJob description Receive and check claim documents for completeness and advice employees regarding pending documents, if any. - Track and control documents to ensure TAT of claims/cards as per SLA. - Feedback from Insurers and Corporates. - Additional revenue opportunities from existing Corporates. Non voice coordinator - Maintain weekly reports on claims...
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Claims Representative
5 days ago
Vadodara, India Nucleon Health Full timeJoin Our Team as a Health Insurance Claims Executive!Location: Vadodara | Full-time | On-siteRole OverviewWe’re looking for a Health Insurance Claims Executive who is passionate about helping people and ensuring a smooth claim experience. In this role, you’ll act as the bridge between customers, hospitals, and insurers—handling claims with accuracy,...
