Manager - Health Claims (Medico)
4 weeks ago
A Medical Reviewer at Prudent Insurance Brokers would be responsible for reviewing medical information and data related to insurance claims, ensuring accuracy, completeness, and compliance with relevant regulations. They would analyse medical reports, documents, and data to determine the validity of claims and provide recommendations for claim processing. This role requires a strong understanding of medical terminology, clinical practices, and insurance regulations.
Key Responsibilities:
- Analyse medical records, reports, and data to assess the validity and accuracy of insurance claims.
- Ensure that all medical information and claim processing adheres to relevant regulations and standards.
- Determine the legitimacy of claims based on medical evidence and insurance policies.
- Work with internal teams (claims, operations, sales) and external stakeholders (clients, medical professionals).
- Generate reports and documentation related to reviewed claims.
- Stay updated on medical advancements and regulatory changes to improve processes.
Required Skills:
- Medical Knowledge: Strong understanding of medical terminology, anatomy, physiology, and common medical conditions.
- Critical Thinking: Ability to analyse data, identify inconsistencies, and make sound judgments.
- Communication: Effective verbal and written communication skills to interact with clients and colleagues.
- Attention to Detail: Meticulous approach to ensure accuracy and completeness in all work.
- Regulatory Compliance: Knowledge of relevant insurance regulations and standards.
- Problem-Solving: Ability to identify and resolve discrepancies or issues within claims.
Qualification required: MBBS/BHMS/BAMS/BUMS/BDS (with TPA/Insurance Company/Brokers background and good medical knowledge)
Experience Required: 3-5 years in claims (cashless/reimbursement)
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