Medical Policy and Claim Advisor

1 day ago

Jaipur Rajasthan, India Hyrmus Full time

**Medical Policy & Scheme Advisor**

This job is for someone who has medical knowledge and has worked with government health schemes like RGHS. The company wants someone who understands how these schemes work, how claims are processed, and can guide the team on the right rules and processes.

**Location & Timing**:
Location: Bhopal (For 3 months, and after that you will shift to Jaipur's office) (Work from office)

Timings: Monday to Saturday, 10:00 AM to 6:00 PM

**Responsibilities**:
Guide on government schemes:
You'll be the go-to person for anything related to schemes like RGHS, MAA Yojana, and PMJAY - how they work, what’s covered, what procedures are allowed, and how to use them correctly.

Mapping codes:
These schemes have different packages and codes. You’ll match them so everything stays in sync and the system works smoothly.

Create rules and protocols:
You’ll help prepare internal documents and rules based on Standard Treatment Guidelines (STGs) - this is like a fixed way of treating certain conditions.

Help with medical codes:
You should know coding systems like ICD and SNOMED - these are used in medical records and claims.

Handle complex queries:
If there is any confusion or technical issue related to schemes or claims, you’ll help solve it.

Support claims process:
You’ll help improve how claims are processed for these schemes, making sure they are done properly and quickly.

Stay updated:
Government health schemes change from time to time - you need to keep yourself updated and help the team stay informed.

Training the team:
You may also create training material or help explain things to your internal team.

You must have a medical degree like MBBS, BAMS, BHMS, BUMS, or

You have worked on a TPA desk (desk where claim processing is done) with good clinical understanding.

Minimum 3 years of experience with government health schemes like RGHS, PMJAY, etc.

You must know how claims work, what documents are needed, and how they are approved or rejected.

You should understand medical codes like ICD-10, SNOMED CT.

You should know how to compare and work with different scheme benefit packages.

You should know how to create medical rules based on standard guidelines.

If you know how TPAs (Third Party Administrators) work and how claims are managed, that’s a big plus.

Extra skills that are nice to have (Not compulsory):
Certification in healthcare management.

Experience with digital healthcare platforms or IT systems.

Good at problem-solving and communication.

Can work alone or in remote settings.

If you’ve done medical audits, that's an extra advantage.

In Short:
**Job Types**: Full-time, Permanent

Pay: ₹25,000.00 - ₹45,000.00 per month

Pay: ₹25,000.00 - ₹45,000.00 per month

**Benefits**:

- Health insurance
- Provident Fund

Schedule:

- Day shift

Supplemental Pay:

- Performance bonus
- Yearly bonus

**Experience**:

- RGHS Medical policy advisor: 1 year (required)

Work Location: In person

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