- Job Title: Medical Officer – IPD (RI)
- Department: Claims
- Location: Bangalore White Filed
As per business requirement
Reporting To: Team Lead / Manager – Medical Services
Job Summary
The Medical Officer (IPD – RI) is responsible for reviewing inpatient (IPD) health insurance claims, evaluating medical necessity, ensuring compliance with policy terms and clinical guidelines, and supporting timely claim decisions while maintaining quality standards.
Key Responsibilities
- Review and assess IPD health insurance claims.
- Verify diagnosis, treatment, investigations, and medical necessity.
- Scrutinize hospital records and supporting documents.
- Ensure claims comply with policy terms, medical protocols, and regulatory guidelines.
- Approve, query, or recommend rejection of claims based on medical findings.
- Coordinate with hospitals, claims teams, and internal stakeholders for additional medical information.
- Maintain turnaround time (TAT) and quality benchmarks.
- Document claim decisions accurately in the claims management system.
- Support audits, quality checks, and process improvement initiatives.
- Stay updated with medical advancements, treatment protocols, and insurance guidelines.
Eligibility
- BAMS/BHMS/BDS (as per company policy).
- Valid registration with the respective medical council (where applicable).
Experience
- 0–3 years of experience in health insurance, TPA, or hospital claims.
- Freshers with good clinical knowledge may also be considered.
Required Skills
- Strong clinical and medical knowledge.
- Understanding of IPD claim adjudication processes.
- Knowledge of health insurance and TPA operations.
- Good analytical and decision-making skills.
- Excellent communication and documentation abilities.
- Proficiency in MS Office and claims processing systems.
- Ability to work under defined TATs and quality parameters.
Key Competencies
- Attention to detail
- Clinical judgment
- Analytical thinking
- Teamwork
- Time management
- Customer focus
- Integrity and confidentiality
Job Type: Full-time
Pay: ₹28,000.00 - ₹35,000.00 per month
Benefits:
- Health insurance
- Leave encashment
- Life insurance
- Provident Fund
Education:
Experience:
- total work: 1 year (Preferred)
Work Location: In person
