Consultant Medical Officer

4 days ago


Andheri, India Medi Assist Insurance TPA Private Limited Full time

Roles & Responsibilities:

  • Claim Processing: Verify the medical admissibility of a claim by confirming diagnosis and treatment details.
  • Claim Scrutiny: Scrutinize claims according to the terms and conditions of the insurance policy.
  • Data Interpretation: Interpret ICD coding, evaluate co-pay details, and classify non-medical expenses, room tariffs, and capping details. Differentiate between open billing and package deals.
  • Process Verification: Understand the process difference between a PA and an RI claim, and verify necessary details accordingly.
  • Document Verification: Verify all required documents for processing claims and raise an IR (Information Request) if documents are insufficient.
  • Team Coordination: Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of a tariff.
  • Claim Approval: Approve or deny claims as per the terms and conditions within the TAT (Turnaround Time).
  • Communication: Handle escalations and respond to emails promptly.

Interested candidates can share their resumes via email or WhatsApp:

  • Email:
  • WhatsApp:

Job Type: Full-time

Pay: ₹335, ₹430,000.00 per year

Benefits:

  • Health insurance
  • Paid sick time
  • Paid time off
  • Provident Fund

Application Question(s):

  • What is your current CTC?
  • How many years of experience do you have?
  • Do you have a degree in BPT / BSc. Nursing/ BAMS/ BHMS/ MBBS?

Work Location: In person


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