Medical Officer

2 days ago


Mumbai, Maharashtra, India Paramount Healthcare Management Pvt Ltd Full time ₹ 24,00,000 - ₹ 36,00,000 per year

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.

Job Type: Full-time

Pay: ₹30, ₹35,000.00 per month

Work Location: In person



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