Medical Officer
2 weeks ago
Job Title: Medical Officer / TPA Doctor Reporting To: CFO Job Purpose: To evaluate, process, and approve health insurance claims, provide medical opinions, and ensure compliance with policy terms, medical guidelines, and regulatory standards for the TPA. Key Responsibilities: Claims & Pre-Authorization: - Review and process cashless pre-authorization requests from network hospitals. - Assess medical necessity, diagnosis, treatment plans, and estimated costs. - Approve, query, or deny requests as per policy terms and medical protocols. - Review final bills and discharge summaries for claim settlement. Medical Evaluation: - Provide medical opinions on hospitalization, procedures, and length of stay. - Identify non-admissible expenses and policy exclusions. - Ensure adherence to standard treatment guidelines (STGs). Coordination & Communication: - Coordinate with network hospitals, treating doctors, and TPA operations teams. - Clarify medical queries with hospitals for claim processing. - Support customer service teams for medical escalations. Compliance & Documentation: - Ensure compliance with IRDAI guidelines, insurer policies, and internal SOPs. - Maintain proper medical documentation and audit trails. - Support internal and external audits. Quality & Fraud Control: - Assist in fraud detection, abuse, and overbilling cases. - Flag suspicious or high-risk claims for investigation. - Participate in claim quality reviews and process improvements. Qualifications: - MBBS, BHMS, BAMS - Valid Medical Council registration (NMC / State Medical Council) Experience: - 1–5 years of clinical or TPA/insurance experience - Experience in claims processing / pre-authorization is an advantage - Fresh MBBS candidates may be considered for junior roles Skills & Competencies: - Strong knowledge of clinical protocols and medical terminology - Understanding of health insurance policies and claim processes - Good analytical and decision-making skills - Excellent communication and documentation skills - Basic computer knowledge (HIS, TPA portals, MS Office) Work Environment: - Office-based / Hybrid (as per company policy) - Rotational shifts may apply Key Performance Indicators (KPIs): - Claim turnaround time (TAT) - Accuracy of medical decisions - Compliance and audit scores - Quality of documentation
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Medical Officer
2 weeks ago
Vadodara, India Dream Makers Full timeBasic level of health care data analysis, team player, effective communication skills, perform well in team environment, knowledge of medical terminology, assessment, patient evaluation and clinical medicine. Experience 0 - 3 Years No. of Openings 20 Education MBBS Role Medical Officer Industry Type Hospitals / Medical / Healthcare Equipments Gender ( Male /...
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Medical Officer
4 days ago
Vadodara, India Dream Makers Full timeBasic level of health care data analysis, team player, effective communication skills, perform well in team environment, knowledge of medical terminology, assessment, patient evaluation and clinical medicine. Experience 0 - 3 Years No. of Openings 20 Education MBBS Role Medical Officer Industry Type Hospitals / Medical / Healthcare Equipments Gender [ Male /...
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Medical Officer
7 days ago
vadodara, India Asian Hires Full timeNon-Clinical Job in US based MNC located in Vadodara, Gujarat Location (On-site job)Company budget: 6,20,000 PA. (For FRESHER'S)1-2 year experienced up to 8,50,000 PA.About the Role - The role will be to review and verify large volumes of patient's full medical records with precision, perform clinical reviews as defined by the specific review methodologies...
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Medical Officer
16 hours ago
Vadodara, Gujarat, India Invention Placement Services Full time**Description** - We are looking for a medical officer for our unit who have experience of opd and ipd patients. - Who have a knowledge of basic computer also. - We have 15 bedded surgical and medicine unit where you have to run individually. - Conduct thorough medical examinations and assessments of patients. - Diagnose and manage acute and chronic medical...
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Medical Officer
2 weeks ago
Vadodara, India Nucleon Health Full timeJob Title: Medical Officer / TPA Doctor Reporting To: CFO Job Purpose: To evaluate, process, and approve health insurance claims, provide medical opinions, and ensure compliance with policy terms, medical guidelines, and regulatory standards for the TPA. Key Responsibilities: Claims & Pre-Authorization: - Review and process cashless pre-authorization...
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Medical Officer
2 weeks ago
Vadodara, India Nucleon Health Full timeJob Title: Medical Officer / TPA DoctorReporting To: CFO Job Purpose:To evaluate, process, and approve health insurance claims, provide medical opinions, and ensure compliance with policy terms, medical guidelines, and regulatory standards for the TPA. Key Responsibilities: Claims & Pre-Authorization:- Review and process cashless pre-authorization...
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Medical Officer
1 week ago
vadodara, India Nucleon Health Full timeJob Title: Medical Officer / TPA DoctorReporting To: CFO Job Purpose:To evaluate, process, and approve health insurance claims, provide medical opinions, and ensure compliance with policy terms, medical guidelines, and regulatory standards for the TPA. Key Responsibilities: Claims & Pre-Authorization:- Review and process cashless pre-authorization...
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Hiring Medical Officer For Vadodara
2 weeks ago
Vadodara, India Dream Makers Full timeAnalysis and summarizing medical records for pre post settlement project Experience 0 - 6 Years No. of Openings 20 Education MBBS Role Medical Officer Industry Type Hospitals / Medical / Healthcare Equipments Gender ( Male / Female ) Job Country India Type of Job Full Time (Night Shift) Work Location Type Work from Office Face interview location Vadodara
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Hiring Medical Officer For Vadodara
7 days ago
Vadodara, India Dream Makers Full timeAnalysis and summarizing medical records for pre post settlement project Experience 0 - 6 Years No. of Openings 20 Education MBBS Role Medical Officer Industry Type Hospitals / Medical / Healthcare Equipments Gender [ Male / Female ] Job Country India Type of Job Full Time (Night Shift) Work Location Type Work from Office Face interview location Vadodara
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Medical Officer
2 weeks ago
Vadodara, India Nucleon Health Full timeJob Title: Medical Officer / TPA DoctorReporting To: CFOJob Purpose:To evaluate, process, and approve health insurance claims, provide medical opinions, and ensure compliance with policy terms, medical guidelines, and regulatory standards for the TPA.Key Responsibilities:Claims & Pre-Authorization:- Review and process cashless pre-authorization requests from...
