Medical Professional with Claims Adjudication Expertise
6 days ago
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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