Medical Officer - Bams Bhms & Mbbs @begumpet
- I Share Business
- 0 - 5 years
- Hyderabad
- 8 months ago
- Email to a friend
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Job Description
Job Title: Claims Processing - Medical Officer
Locations: Hyderabad & Delhi
Department: Claims Processing
Job Description:
We are looking for motivated and detail-oriented professionals to join our Claims Processing. The ideal candidate should have a medical background fresher and experience in cashless request handling and claims processing either at a TPA or hospital billing desk or exposure working with insurance company.
Key Responsibilities:
- Process Cashless Authorization Requests & Health Insurance Claims under NHA scheme.
- Provide medical opinion and adjudication for health insurance claims within stipulated timelines.
- Evaluate and process claims as per defined NHA guidelines, SOPs, and policy conditions.
- Apply knowledge of ICD coding, procedure codes, and standard treatment protocols for proper case assessment.
- Ensure timely and accurate processing to meet Turnaround Time (TAT) benchmarks.
- Manage high-volume claim loads efficiently with a focus on accuracy and compliance.
- Ensure cost control and effective claim case management in line with NHA mandates.
- Maintain comprehensive documentation and ensure data integrity in the claims processing system.
- Coordinate with hospitals, beneficiaries, and internal teams for smooth case closure.
Desirable Skills:
- Minimum 6 months to 5 year of experience in handling Cashless/Reimbursement claims in a TPA or hospital setup or from insurance company exposure.
- Familiarity with TPA workflows, hospital insurance desk protocols, and billing processes.
- Strong understanding of health insurance operations under public or private schemes.
- Proficiency in medical terminology, coding systems (ICD/Procedure codes), and healthcare guidelines.
- Good communication skills oral and written.
- Mandatory computer proficiency and comfort with medical/insurance software systems.
Educational Qualification:
- MBBS / BAMS / BHMS / BUMS or equivalent medical degree.
Work Experience:
- Minimum 0 months to 5 year in Claims Processing / TPA operations / Hospital or Insurance company.
Interested candidate can share his cv to SA*************R@IS******A.IN
Job Classification
Industry: InsuranceFunctional Area / Department: Healthcare & Life Sciences, Role Category: DoctorRole: Medical OfficerEmployement Type: FreshersContact Details:
Company: I Share BusinessLocation(s): Hyderabad
Keyskills: Health Claims TPA Claim Settlement Claims Processing Claims Adjudication
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