Medical Officer
4 days ago
Medical Claims Review:
Analyze and assess pre-authorization and post-treatment reimbursement claims.
Review medical records, diagnosis, investigation reports, and treatment plans to ensure clinical appropriateness and policy alignment.
Validate claims based on insurance policies, internal guidelines.
Decision Making:
Determine the admissibility or rejection of claims and recommend the claim amount.
Coordinate with claims team and finance for timely claim settlements.
Communication & Coordination:
Liaise with hospitals, policyholders, and internal teams to clarify documentation or medical details.
Provide medical inputs to customer support or grievance redressal teams when needed.
Documentation & Reporting:
Maintain accurate and updated documentation of all reviewed cases.
Support audit and compliance processes by ensuring claims are processed with proper medical justification.
Quality & Compliance:
Ensure adherence to TATs (Turn Around Times) and SLAs (Service Level Agreements).
Maintain confidentiality and handle sensitive health data in compliance with data protection regulations.
Pay: ₹30,000.00 - ₹35,000.00 per month
Work Location: In person
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16 hours ago
Maroshi, Mumbai, Maharashtra, India Paramount Healthcare Management Pvt Ltd Full timeParamount is presently servicing more than 50 lakh lives managing Corporate and Individual Policies and an additional 4 crores lives managing State Government Health Policies. Recipient of 'TPA of the Year' award for two consecutive years at the India Insurance Summit & Awards (2018 & 2019) We are hiring doctors for medi - claim processing hence medically...
