Medical Officer

1 day ago


Chennai District Tamil Nadu, India Link-K Insurance TPA Private Ltd Full time

**Greeting From Link-K Insurance TPA Pvt Ltd**

We are hiring **Senior Medical Officer** for our **Claims Team**at our **Chennai Corporate office.**

**Job Role**:Medical Officer

**Industry**:TPA/Health Insurance

**Location**:Anna Nagar, Chennai

**Experience**: 3 Years+

**Qualification**:MBBS, BDS, BAMS, BHMS,..

**Roles & Responsibilities**:

- Processing of health insurance claims submitted by policyholders, hospitals, or healthcare providers.
- Get fully trained and understand claims software, functionality and validations.
- Verify whether the claim falls within the coverage/ scope of the health insurance policy.
- Check medical details in the claim documents and determine admissibility of the claim.
- Examine medical records, diagnostic reports, treatment plans, and other relevant documents to verify the authenticity and medical necessity of the services claimed.
- Check for pre-existing conditions, policy exclusions, waiting periods, and any other relevant policy provisions.
- Coding of ailments /procedures as per the regulatory requirement of coding the ailments/diseases/ procedures
- Validate the accuracy billing information submitted in the claims to prevent fraudulent or inflated billing.
- Evaluate the medical necessity of the treatments or procedures claimed, considering standard medical guidelines and best practices.
- Raising appropriate queries to hospitals, doctors, other healthcare providers and members to gather additional information or clarify details related to the claims.
- Be vigilant in identifying potential fraudulent claims and report them to the appropriate authorities for further investigation.
- Make informed decisions regarding the approval, partial approval, or denial of insurance claims based on the medical assessment and policy terms and conditions.
- Maintain a high level of accuracy and quality in claims processing to ensure customer satisfaction and adherence to regulatory standards.
- Help and support to other team members in billing, quality check, CRM, CS and contact center to clarify customer queries satisfactorily.
- Stay up-to-date with relevant healthcare laws, regulations and industry standards to ensure compliance in claims processing.
- Give necessary inputs to team leads for enhancement in IT system and better processes.
- Regular interaction with Provider Network management team and claims investigation teams to give inputs about the billing practices of hospitals for better negotiations, any suspected fraudulent billing practices noticed to red flag providers and suggestion for better internal controls.

**Important Note**:
**Job Types**: Full-time, Permanent

Pay: ₹30,000.00 - ₹35,000.00 per month

**Benefits**:

- Provident Fund

Schedule:

- Day shift

Work Location: In person


  • Duty Medical Officer

    2 weeks ago


    Erode, Tamil Nadu, India CK MEDICAL CENTER HOSPITAL Full time

    CK Medical Center Hospital is looking for a dedicated and compassionate **Duty Medical Officer** to join our medical team. If you're an MBBS-qualified professional committed to providing quality patient care, we’d love to hear from you. **Position Details**: - **Role**: Duty Medical Officer - **Shift**: Day Shift (Rotational) - **Qualification**: MBBS...

  • Duty Medical Officer

    2 weeks ago


    Erode, Tamil Nadu, India CK MEDICAL CENTER HOSPITAL Full time

    CK Medical Center Hospital is looking for a dedicated and compassionate **Duty Medical Officer** to join our medical team. If you're an MBBS-qualified professional committed to providing quality patient care, we’d love to hear from you. **Position Details**: - **Role**: Duty Medical Officer - **Shift**: Day Shift (Rotational) - **Qualification**: MBBS...

  • Medical Officer

    2 weeks ago


    Chennai, Tamil Nadu, India JH REHABILITATION Full time

    **Job Title: Medical Officer** **Location**: Mogappair ,Chennai **Department**: Physical Rehabilitation ward **Reports To: Head Operation and Managing Director** **Job Summary**: The Medical Officer in the Physical Rehabilitation Hospital is responsible for providing high-quality medical care to patients undergoing rehabilitation. This role involves...

  • Medical Officer

    2 weeks ago


    Chennai, Tamil Nadu, India Symbiance Pharma Solutions Pvt Ltd Full time

    Patient Care: Diagnosing and treating various illnesses, injuries, and disabilities. Performing medical procedures, including physical examinations and diagnostic tests. Prescribing medications and treatments. Monitoring patient progress and adjusting treatment plans. Providing patient education and health management guidance. Collaborating with other...

  • Duty Medical Officer

    2 weeks ago


    Chennai, Tamil Nadu, India Gleneagles Hospital Full time

    **Company Description** Gleneagles Hospitals, part of IHH Healthcare, operates a network of six hospitals in India, known for multi-organ transplants and tertiary care specialties. With a reputation in Oncology, Gastroenterology, Neurosciences, and more, we offer advanced medical technologies and telemedicine services. Our hospitals provide emergency and...

  • Medical Officer

    5 days ago


    Palakkad district, India Azeezia Medical College Hospital, Alathur, Palakkad Full time

    Patient care: Assessing patient conditions, providing diagnoses, and managing patient care - Medical records: Creating and updating patient medical records - Medical research: Conducting medical research - Prescriptions: Prescribing medication and treatment instructions - Collaboration: Collaborating with other healthcare professionals on patient care -...


  • Coimbatore, Tamil Nadu, India Karpagam Medical College and Hospital Full time

    **Responsibilities**: - Provide emergency medical care to patients presenting with acute illnesses or injuries. - Conduct initial assessments, including vital signs monitoring, medical history review, and physical examinations. - Diagnose medical conditions and develop appropriate treatment plans. - Administer medications, intravenous fluids, and other...

  • Medical Officer

    3 days ago


    Coimbatore, Tamil Nadu, India Amrita University Full time

    Job Title Medical Officer Location Coimbatore, Tamil Nadu Required Number 1 Qualification MBBS Job Description The Medical Officer will work along with other two Medical officers in Day and Night shift. Provide primary health care and first aid to students, faculty and residents of the campus. Job Category Non-Teaching


  • Chennai, Tamil Nadu, India A4 Hospital Fertility Centre Full time

    **Job Title: Duty Medical Officer** **Location**: [A4 Hospitals & Fertility Center ], [Chennai, Tamil nadu/INDIA] **Job Type**: Full-Time **Reports To**: DMO LEADS **About Us**: A4 Hospitals & fertility Centre is a leading fertility clinic dedicated to providing compassionate, personalized care to individuals and couples seeking to build their families....


  • Chennai, Tamil Nadu, India Gleneagles Hospital Full time

    **Company Description** Gleneagles Hospitals, a part of IHH Healthcare, is a renowned multi-organ transplant and tertiary care multi-specialty hospital network in India. With hospitals in Hyderabad, Bengaluru, Chennai, and Mumbai, we are known for our expertise in Oncology, Gastroenterology, Cancer Care, Neurosciences, Urology, and Cardiac Sciences. Our...