Looking For Health Claims Doctor @

1 day ago

Navi Mumbai, Maharashtra, India ICICI Lombard Full time ₹ 12,00,000 - ₹ 24,00,000 per year

Job Summary:

We are seeking a qualified and experienced medical professional with a strong background in health insurance claim settlement and customer service. The ideal candidate will leverage their clinical knowledge to evaluate and process health insurance claims efficiently while ensuring a high level of customer satisfaction. This hybrid role bridges the gap between medical accuracy, regulatory compliance, and empathetic customer support.

Key Responsibilities:

  • Medical Review & Claims Adjudication:
  • Assess and validate medical claims based on clinical documentation and policy coverage.
  • Interpret diagnostic reports, treatment plans, and prescriptions to determine claim eligibility.
  • Coordinate with internal medical teams to ensure accuracy in claims decision-making.
  • Customer Interaction & Support:
  • Communicate with policyholders, hospitals, and third-party administrators (TPAs) to explain claim decisions in a clear and professional manner.
  • Handle escalated or complex customer service issues involving medical claims.
  • Offer support and guidance on claim submission processes and documentation requirements.
  • Compliance & Documentation:
  • Ensure all claims are processed in compliance with IRDAI regulations and internal guidelines.
  • Maintain accurate records of claim assessments, approvals, denials, and communications.

Required Qualifications:

  • Education:

  • MBBS, BDS, BHMS, BAMS, or equivalent medical degree. Postgraduate qualifications in healthcare or insurance are a plus.

  • Experience:

  • Minimum 25 years of experience in health insurance, especially in claims processing, medical underwriting, or TPA operations.

  • Proven track record of customer service experience in a healthcare or insurance setting.

  • Skills:

  • Strong clinical judgment and attention to detail.
  • Excellent communication and interpersonal skills.
  • Proficient in claims management systems and MS Office.
  • Ability to handle sensitive medical information with confidentiality and professionalism.

Regards,

Human Resource

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