Medical Professional with Claims Adjudication Expertise

6 days ago


Mumbai, Maharashtra, India Volo Health Insurance TPA Pvt Ltd Full time

Location: Mumbai/Bangalore, India

Job Type: Full-time

Job Summary: We are seeking a skilled Medical Officer to join our team at Volo Health Insurance TPA Pvt Ltd. As a Medical Officer, you will be responsible for evaluating medical admissibility of claims and providing expert opinions.

Key Responsibilities:

  • Evaluate medical admissibility of claims by verifying diagnosis and treatment details.
  • Scrutinize claims in line with health insurance policies and terms.
  • Provide expert medical opinions for health insurance claims.
  • Process cashless requests and claim documents efficiently.
  • Maintain Standard Operating Procedures (SOPs) and protocols.
  • Perform ailment-wise ICD and procedure coding.
  • Identify and report potential insurance-related fraud triggers.
  • Manage claim volumes effectively to meet turnaround time targets.
  • Oversee claim case management and cost management.

Requirements:

  • Qualifications: BAMS / BHMS / MBBS or equivalent.
  • Experience: Minimum 1 year in claims processing.
  • Strong knowledge of medical terminologies, health insurance policies, and claims adjudication.
  • Excellent oral and written communication, negotiation, and decision-making skills.
  • Proficiency in MS Excel and a customer-centric mindset.
  • Ability to adapt to a fast-paced environment with shifting priorities.

Estimated Salary: ₹7,50,000 - ₹9,00,000 per annum based on industry standards, location, and experience.



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