Senior Medical Officer

Why This Role Matters

The Senior Medical Officer plays a crucial role in ensuring fair, accurate, and timely health insurance claim decisions. This position directly impacts patient access to care, cost optimization for insurers, and overall trust in the healthcare insurance ecosystem.

Job Description

Onsurity is hiring a Senior Medical Officer for its Kolkata location. The role involves reviewing and adjudicating health insurance claims, ensuring compliance with medical and policy guidelines, and collaborating with stakeholders to deliver efficient and ethical claim decisions.

Key Features

• Position: Senior Medical Officer
• Organization: Onsurity
• Employment Type: Full-time
• Work Mode: On-site
• Location: Kolkata

Responsibilities

• Evaluate cashless and reimbursement claims including IPD, day-care, and complex cases
• Interpret diagnosis, treatment plans, and investigations to determine claim admissibility
• Recommend approvals, partial approvals, or denials with clear medical reasoning
• Review pre-authorization requests and discharge approvals within TAT
• Handle billing disputes and coordinate with hospitals and TPA teams
• Ensure compliance with IRDAI guidelines and internal SOPs
• Maintain accurate documentation for audits and claim tracking
• Identify fraudulent or suspicious claims and recommend further investigation
• Collaborate with internal teams and insurers for case resolution
• Participate in audits, training sessions, and process improvement initiatives
• Mentor junior staff and support medical governance practices

Required Qualification

MBBS / BAMS / BHMS or equivalent medical degree from a recognized institution

Important Requirements

• 5–10 years of experience with at least 5+ years in insurance/TPA claims adjudication
• Strong understanding of health insurance policies and claim processes
• Knowledge of IPD, surgical procedures, and treatment protocols
• Ability to work in high-volume, fast-paced environments
• Excellent documentation and analytical skills
• Strong communication skills in English (Hindi/Kannada is a plus)
• High ethical standards and customer-centric approach

Employment Options

• Full-time permanent role
• On-site position in insurance/health-tech environment
• Opportunity to work in medical claims and healthcare operations

What We Offer

• Competitive salary and benefits
• Medical insurance coverage
• Opportunity to work in a fast-growing health-tech company
• Collaborative and innovation-driven work culture

Experience and Skills

• Experience in claims adjudication (cashless and reimbursement)
• Strong clinical and insurance domain knowledge
• Fraud detection and cost optimization skills
• Stakeholder coordination and case resolution expertise
• Process improvement and mentoring abilities

Salary Insights

Salary not disclosed (expected to be competitive as per industry standards)

Company Overview

Onsurity is a rapidly growing health-tech platform focused on providing employee healthcare benefits. The company aims to simplify healthcare access and insurance processes through innovative solutions, ensuring better outcomes for both employees and organizations.

FAQs

1. Where is the job located?
   The role is based in Kolkata, West Bengal.

2. What type of employment is offered?
   This is a full-time, on-site position.

3. What does the role involve?
   The Senior Medical Officer reviews and adjudicates health insurance claims and ensures compliance with policies.

4. What experience is required?
   At least 5+ years of experience in insurance/TPA claims adjudication is required.

Application Tips

• Highlight your experience in insurance claims adjudication
• Showcase your knowledge of policy wording and medical necessity
• Emphasize analytical, documentation, and fraud detection skills
• Mention your ability to work in fast-paced, high-volume environments