ABOUT THE ROLE
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We are looking for a Medical Officer with strong knowledge of ECHS, CGHS, and third-party administrator (TPA) processes. This is a corporate role focused on medical claims review, pre-authorization, and insurance coordination. The ideal candidate will have 2–6 years of relevant experience and a sound understanding of health insurance operations and medical documentation standards.
KEY RESPONSIBILITIES
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- Review and process health insurance claims under ECHS, CGHS, and other TPA schemes
- Evaluate pre-authorization and enhancement requests with clinical correlation
- Analyze discharge summaries, investigation reports, and treatment records for claim validation
- Verify medical necessity and appropriateness of treatment as per policy and clinical standards
- Identify documentation discrepancies and raise clinical queries with empanelled hospitals
- Coordinate with hospitals, insurers, and internal teams for smooth claim processing
- Ensure compliance with NHA, PMJAY, and Ayushman Bharat guidelines
- Maintain accurate documentation and adhere to defined turnaround time (TAT)
- Stay updated on latest insurance policies, healthcare regulations, and government scheme guidelines
REQUIRED SKILLS & QUALIFICATIONS
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- Ayush or BAMS degree (registered practitioner preferred)
- Minimum 2–5 years of experience in TPA, health insurance, or claims review
- In-depth knowledge of ECHS, CGHS, and other TPA / insurance processes
- Strong understanding of medical documentation and claims review standards
- Good analytical ability and sound clinical judgment for claims evaluation
- Accuracy and attention to detail in documentation
- Effective communication and coordination skills
PREFERRED EXPERIENCE
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- Prior experience in a TPA company, insurance firm, or health insurance desk
- Hands-on experience with PMJAY / Ayushman Bharat claim processing
- Knowledge of ECHS / CGHS empanelment norms and billing procedures
- Familiarity with NHA protocols and government health scheme guidelines
BENEFITS
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- Salary up to ₹8,00,000 per annum (based on experience)
- Paid time off
- Growth opportunity in the health insurance and TPA sector
JOB DETAILS
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- Job Type: Full-Time
- Work Location: In-Person (On-site)
Pay: Up to ₹800,000.00 per year
Benefits:
- Life insurance
- Paid time off
Work Location: In person
