Medical Officer

Roles & Responsibilities
• Review medical claims submitted by policyholders to ensure accuracy and compliance with insurance policies.
• Analyze medical documentation provided by hospitals, clinics, and other healthcare providers to determine the legitimacy of claims.
• Assess the medical necessity of procedures, treatments, and hospital admissions as per the insurance policy guidelines.
• Provide second opinions or consultations on disputed claims or complex medical cases.
• Perform risk assessments based on medical data and historical trends to evaluate and manage potential risks for both policyholders and insurers.
• Analyze patient medical history and treatment plans to identify high-risk cases and potential fraud.
• Collaborate with the underwriting team to provide insights into risk factors and potential areas of concern in the policyholder pool.
• Assist in the development of health insurance policy guidelines to ensure they are medically sound and compliant with regulatory standards.
• Stay updated on the latest medical trends, technologies, and regulations to ensure policies reflect current medical practices.
• Ensure compliance with healthcare laws and insurance industry regulations during the claims processing and risk evaluation stages.
• Conduct medical audits to ensure the accuracy of claims and prevent fraud.

Qualification
• Medical degree (MBBS, MD, or equivalent) from a recognized institution.
• Relevant specialization (e.g., General Medicine, Surgery) is a plus.

Experience
• Minimum of 5 years of experience in the healthcare industry, ideally in a clinical or insurance-related environment.
• Experience with medical claims evaluation, health insurance, or risk management is highly desirable.
• Familiarity with healthcare laws, regulations, and insurance policies is a plus.

Vacancies
• 1 Medical Officer position available.

Skills
• Strong understanding of medical terminology, clinical procedures, and healthcare protocols.
• Ability to assess medical documents, interpret medical records, and determine the legitimacy of medical claims.
• Analytical skills for risk assessment and decision-making.
• Good communication skills to explain medical matters to non-medical professionals (e.g., insurance teams).
• Ability to handle sensitive information and ensure confidentiality.

About the Company
Policybazaar for Business is a leading platform providing insurance solutions and services. The company aims to offer customers comprehensive insurance options, leveraging its advanced technology and professional expertise. With a focus on customer satisfaction, Policybazaar helps businesses and individuals navigate the complexities of insurance policies, claims processing, and risk management.