Senior medical officer

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 cases
• Understand and process differences between PA and reimbursement (RI) claims
• 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 claim escalations and respond to internal and external emails
• Manage domestic and international client calls professionally
• Work in rotational shifts, including night shifts

Qualification
• BAMS / BHMS / BDS from a recognized institution

Experience
• Clinical experience or TPA / insurance claims experience preferred
• Freshers with strong medical knowledge may be considered

Skills
• Strong medical terminology and clinical understanding
• Knowledge of ICD coding and insurance claims processes
• Analytical and decision-making ability
• Attention to detail and documentation accuracy
• Good verbal and written communication skills

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