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

  • Claims Executive

    1 day ago

    Jaipur, Rajasthan, India Vidal Health Insurance TPA Private Limited Full time

    Vidal is hiring for Claims-Executive Work Location: Gurgaon **Work from Office only** **Key Responsibilities** **Claim Review & Validation** - Examine submitted claims for completeness and accuracy - Verify policy coverage and eligibility - Identify discrepancies or missing documentation **Claims Processing** - Enter and adjudicate claims in the system...

  • Health Claims

    2 weeks ago

    Jaipur, India Shriram General Insurance Full time

    **Health Claims - Medical team** **Designation **:Manager **Location**: Corporate Office, Jaipur **Role **:Health Claims - Medical team - Medical background with good clinical knowledge - Full understanding of health insurance products available in the market - Having experience of identifying possible frauds and leakages in the health claims processing -...

  • Pa-claims

    2 weeks ago

    Jaipur, Rajasthan, India Genpact Full time

    Genpact (NYSE: G) is a global professional services and solutions firm delivering outcomes that shape the future. Our 125,000+ people across 30+ countries are driven by our innate curiosity, entrepreneurial agility, and desire to create lasting value for clients. Powered by our purpose - the relentless pursuit of a world that works better for people - we...

  • Process Associate-claims

    5 days ago

    Jaipur, Rajasthan, India Genpact Full time

    Genpact (NYSE: G) is a global professional services and solutions firm delivering outcomes that shape the future. Our 125,000+ people across 30+ countries are driven by our innate curiosity, entrepreneurial agility, and desire to create lasting value for clients._**_ _**_Powered by our purpose - the relentless pursuit of a world that works better for people...

  • Claim Processor-executive

    7 days ago

    Jaipur, Rajasthan, India Vidal Health Insurance TPA Private Limited Full time

    Vidal is hiring for claim Processor-Executive Level for Jaipur. Location: Jaipur Job Timings: 9:30AM to 5:30PM Monday to Saturday Work from Office only 1.Claim processing 2.Medical Terminology Knowledge and exp in Claim processing in 1 or 2 yrs of exp. Immediate Joiner will be preferred. **Job Types**: Full-time, Permanent Pay: ₹18,000.00 -...

  • Medical Officer

    2 weeks ago

    Jaipur, Rajasthan, India Heritage health insurance TPA Full time

    The Medical Officer - Claims Processing is responsible for evaluating the medical aspects of insurance claims to ensure accurate, timely, and fair claim settlements. This includes reviewing medical records, assessing the necessity and appropriateness of treatments, verifying diagnoses, and helping to detect fraud or overbilling. **Job Types**: Full-time,...

  • Claims Processor Non Medico

    1 week ago

    Jaipur, Rajasthan, India Vidal Health Insurance TPA Private Limited Full time

    Vidal is hiring for Claims-Executive Work Location: Jaipur,Sodala,Ajmer Road **Work from Office only** **Key Responsibilities** Claim processing which includes NME evaluation Tariff applicability Policy T & c Co-pay Discount deduction Investigation criteria knowledge Insurer wise policy T&C knowledge Basic Documentation required for claim...

  • Sr. Insurance Associate

    4 weeks ago

    Jaipur, Rajasthan, India Jobted IN C2 Full time

    Country India Working Schedule Full-Time Work Arrangement Hybrid Relocation Assistance Available No Posted Date 19-Jul-2025 Job ID 10820 Description and Requirements Insurance Associate Position Title Sr Associate Reports to Responsibility Level Assistant Manager Supervises NA Location Jaipur Global Grade GG 8 Complexity PID s...

  • Claims Executive Jaipur Location

    5 days ago

    Jaipur, Rajasthan, India Vidal Health Insurance TPA Private Limited Full time

    Roles and Responsibilities - Expertise in Excel, formulas, V look up etc - Data handling and MIS maintenance. - Escalation handling, interdepartmental coordination. - Knowledge of claims, enrollment, policy etc. - Outstanding monitoring and clearance. - 1-2 years experience in TPA INDUSTRY is preferable.. Pay: Up to ₹15,000.00 per month **Benefits**: -...

  • Agm, Rm

    2 weeks ago

    Jaipur, India Shriram General Insurance Full time

    Job Description Manager - Claims (Two Wheeler/ Private Car/ Commercial Vehicle) Location - Jaipur (Corporate Office) **Position Overview**: We are looking for a highly skilled and experienced professional to join our team as a Manager - Claims at Shriram General Insurance. The Claims Manager will be responsible for overseeing and managing the claims...