Medical Officer

13 hours ago

Anna Nagar Chennai Tamil Nadu, India Link K Insurance TPA Pvt Ltd Full time

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

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

**Job Role: Medical Officer**

**Industry: TPA, Health Insurance**

**Location: Anna Nagar, Chennai**

**Shift Timing : 1PM till 9 Pm (Work From office )**

**Experience: 1 to 5 Years**

**Roles and 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

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

Pay: ₹25,000.00 - ₹40,000.00 per month

**Benefits**:

- Provident Fund

Schedule:

- Evening shift

**Experience**:

- Cash Less and Reimbursement: 1 year (required)

Work Location: In person

  • Medical Officer

    3 days ago

    Anna Nagar, Chennai, Tamil Nadu, India Link K Insurance TPA Pvt Ltd Full time

    **Greetings From Link K Insurance TPA Pvt** We are Hiring **Medical Officer** For our **Claims department** at our **Chennai Corporate office.** **Work From Office** **Year of Experience : 3 to 5 Years** **Qualification**: BAMS, (Bachelor of Ayurveda, Medicine, and Surgery) **Industry**: Any TPA / Health Insurance **Roles And Responsibility** -...

  • Medical Officer Bams

    3 days ago

    Anna Nagar, Chennai, Tamil Nadu, India Link K Insurance TPA P Ltd Full time

    **Greeting From Link K Insurance TPA Pvt Ltd** We are hiring **Medical Officer** for our **Claims Team**at our **Chennai Corporate office.** **Job Role: Medical Officer** **Industry: TPA, Health Insurance** **Location: Anna Nagar, Chennai (Timing 1:00Pm to 9pm )** **Experience: 1 to 5 Years** **Roles and Responsibilities** - Processing of health...

  • Medical Officer Bams

    3 days ago

    Anna Nagar, Chennai, Tamil Nadu, India Link K Insurance TPA Pvt Ltd Full time

    **Greeting From Link K Insurance TPA Pvt Ltd** We are hiring **Medical Officer** for our **Claims Team**at our **Chennai Corporate office.** **Job Role: Medical Officer** **Industry: TPA, Health Insurance** **Location: Anna Nagar, Chennai** **Experience: 1 to 5 Years** **Roles and Responsibilities** - Processing of health insurance claims submitted by...

  • Medical Officer Bams

    2 days ago

    Anna Nagar, Chennai, Tamil Nadu, India Link K Insurance TPA P Ltd Full time

    **Greeting From Link K Insurance TPA Pvt Ltd** We are hiring **Medical Officer** for our **Claims Team**at our **Chennai Corporate office.** **Job Role: Medical Officer** **Industry: TPA, Health Insurance** **Location: Anna Nagar, Chennai (Timing 1:00Pm to 9pm )** **Experience: 1 to 5 Years** **Roles and Responsibilities** - Processing of health...

  • Medical Officer

    2 weeks ago

    Anna Nagar, Chennai, Tamil Nadu, India Link K Insurance TPA Pvt Ltd Full time

    **Greeting From Link K Insurance TPA Pvt Ltd** We are hiring **Medical Officer** for our **Claims Team**at our **Chennai Corporate office.** **Job Role: Medical Officer** **Industry: TPA, Health Insurance** **Location: Anna Nagar, Chennai** **Shift Timing : 1PM till 9 Pm (Work From office )** **Experience: 1 to 5 Years** **Roles and...

  • Duty Medical Officer

    13 hours 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

    13 hours 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...

  • Duty Medical Officer

    3 days ago

    Ramapuram, Chennai, Tamil Nadu, India SRM groups Full time

    Restoring health: Medical officers often provide urgent medical and nursing services through patient's examination and investigation. While restoring the health of patients, they ensure high standard inpatient care. Improving health: These officers verify complex diagnoses and facilitate treatment plans. They play an active role in overseeing the medical...

  • Chief Medical Officer

    3 days ago

    Chennai, Tamil Nadu, India Desirous Global Consulting Full time

    Medical Services/Hospital Full-Time Job ID: DGC00266 Chennai, Tamil Nadu 0-5 Yrs ₹1.5 - ₹05 Yearly Job description for Chief Medical Officer - Qualification: MD Dermatology or Diploma in Dermatology Venerology & Leprosy - Administering treatments, monitoring outcomes and recommending changes in treatment plans when necessary for Hair & Skin. - Educating...

  • Medical Officer

    13 hours ago

    Kilpauk, Chennai, Tamil Nadu, India MEDI ASSIST INSURANCE TPA PRIVATE LIMITED Full time

    **Roles and Responsibilities** 01. Involves Processing of Claims ( Preauthorization / Reimbursement claims) 02. Validating and processing these claims within TAT 03. With good communication and medical Knowledge 04. TPA Experience is an added advantage **Financial**: To see to that there is no financial implication for the organization while settlement...