Medical Officer (Non-Clinical)

*We are seeking MBBS / BHMS / BAMS graduates for a Mediclaim File Processing & Claims Review role. The position is ideal for medical professionals who want to build a career in the Health Insurance, TPA, and Claims Processing sector without being involved in clinical practice.

*The selected candidate will be responsible for reviewing medical records, hospital bills, discharge summaries, investigation reports, and other claim documents to assess whether the treatment and claim are in line with applicable insurance policy terms, conditions, exclusions, and eligibility criteria.

*****Key Responsibilities*******

• Review and verify medical and claim-related documents.
• Assess treatment details against insurance policy guidelines.
• Identify missing documents, discrepancies, inconsistencies, and potential claim concerns.
• Prepare claim assessment reports, case summaries, timelines, and observations.
• Support claim approval, query, rejection/denial, and investigation processes as required.
• Coordinate with Insurance Companies, TPAs, Hospitals, Doctors, Clients, and other stakeholders.
• Follow up for pending documents and required clarifications.
• Maintain accurate records and update claim-related data in internal systems.
• Ensure cases are processed within defined timelines and quality standards.
• Maintain strict confidentiality of patient and insurance information.

*****Candidate Profile******

• Qualification: MBBS / BHMS / BAMS.
• Freshers are welcome to apply.
• Experience in TPA / Health Insurance / Mediclaim / Hospital Administration / Claims Processing will be an advantage.
• Good English & Gujarati communication skills.
• Basic knowledge of MS Word, Excel, Email, and computer applications.
• Good analytical ability, documentation skills, and attention to detail.
• Ability to understand medical terminology and interpret medical documents.
• Willingness to learn insurance policies, claim procedures, and investigation processes.

*****Career Opportunity*****

This role offers an excellent opportunity for medical graduates to develop expertise in Health Insurance Claims, Mediclaim Processing, Medical Document Review,

Claims Assessment, TPA Operations, and Insurance Investigation, with long-term career growth in the insurance sector.

*Suitable for: MBBS / BHMS / BAMS | Freshers |