Medical Officer - Non Clinical

Role & Responsibilities
• Check medical admissibility of insurance claims by validating diagnosis and treatment details
• Scrutinize claims as per insurance policy terms and conditions
• Interpret ICD coding and evaluate co-pay, room tariff, capping, and non-medical expenses
• Differentiate between open billing and package billing
• Understand and process PA and reimbursement claims as per defined workflows
• Verify required documents for claims processing and raise IRs for insufficiencies
• Coordinate with LCM teams for high billing cases and provider teams for tariff issues
• Approve or deny claims within defined turnaround time (TAT)
• Handle escalations and respond to internal and external queries via email

Qualification
• MBBS or equivalent medical qualification
• Knowledge of medical insurance, claims processing, and ICD coding preferred

Experience
• 0 to 1 year of experience in non-clinical roles, claims management, or medical insurance
• Freshers with strong medical knowledge may be considered

Skills
• Strong understanding of insurance policies and claims adjudication
• Knowledge of ICD coding and medical terminology
• Analytical and decision-making skills
• Attention to detail and documentation accuracy
• Effective communication and coordination skills

About the Company
• Medi Assist is a leading health benefits administrator in India, Specializes in health insurance claims management and healthcare services.