Medical Claim Officer jobs

Medical Officer / Senior Medical Officer – TPA Claims

Company: Volo Health Insurance TPA Pvt. Ltd.
Job Type: Full-time
Experience: 1–3 years (Freshers can also apply)
Locations: Mumbai, Pune, Delhi, Bengaluru, Chennai, Hyderabad

Job Summary

Volo Health Insurance TPA Pvt. Ltd. is looking for Medical Officers / Senior Medical Officers to support the processing and medical assessment of cashless and reimbursement health insurance claims. The ideal candidate should have sound clinical knowledge, attention to detail, and the ability to assess medical records in line with insurer guidelines and internal SOPs.

Key Responsibilities

• Assess cashless and reimbursement claims and review medical records.
• Evaluate treatment charges, hospital tariffs, and medical necessity.
• Verify claim documents and identify potential fraud, policy deviations, or discrepancies.
• Ensure timely claim processing in accordance with defined TATs and quality standards.
• Follow insurer guidelines, policy terms, and internal SOPs.
• Provide clinical inputs for complex claim assessments and decisions.

Eligibility Criteria

• Qualification: MBBS / BAMS / BHMS / BUMS only.
• Experience: 1–3 years of relevant experience; TPA claims experience preferred.
• Freshers with the required qualifications may also apply.
• Good clinical assessment, analytical, and documentation skills.
• Immediate joiners preferred; candidates serving their notice period may also apply.

Pay: ₹300,000.00 - ₹600,000.00 per year

Benefits:

• Health insurance
• Provident Fund

Work Location: In person