Medical Claims Officer jobs

Location: Raipur, Chhattisgarh
Experience: 1 – 4 Years
Employment Type: Full-Time/Freelance

Job Summary

We are looking for enthusiastic Medical Officers to join our Cashless Claims team. The role involves reviewing and processing cashless hospitalization requests, evaluating medical records, and ensuring timely authorization of claims in accordance with clinical guidelines and organizational policies.

This opportunity is ideal for BHMS, BAMS, BDS, and BPT graduates who are looking to build a career in the healthcare insurance and TPA industry.

Eligibility

• BHMS
• BAMS
• BDS
• Bachelor of Physiotherapy (BPT)

Experience

• 0.6–2 years of experience
• Candidates with exposure to hospitals, TPAs, health insurance, or medical claims processing will be preferred.

Key Responsibilities

• Review and process cashless hospitalization requests received from network hospitals.
• Analyze patient medical records, diagnosis, treatment plans, investigation reports, and discharge summaries.
• Evaluate the medical necessity and appropriateness of the proposed treatment.
• Authorize, modify, or recommend cashless claims as per clinical guidelines and policy terms.
• Ensure accurate and timely processing of pre-authorization and enhancement requests.
• Coordinate with hospitals, treating doctors, and internal teams to obtain medical clarifications whenever required.
• Maintain the prescribed turnaround time (TAT) and quality standards.
• Document claim decisions accurately in the claims management system.
• Escalate complex or exceptional cases to senior medical reviewers.
• Ensure compliance with organizational, regulatory, and healthcare insurance guidelines.

Required Skills

• Strong knowledge of Anatomy, Physiology, Pathology, Pharmacology, and Medical Terminology.
• Ability to interpret medical records and clinical documentation.
• Good analytical and decision-making skills.
• Excellent attention to detail.
• Good communication and interpersonal skills.
• Basic knowledge of MS Office and computer applications.
• Ability to work in rotational shifts and a target-driven environment.

Preferred Experience

• Cashless Claims Processing
• Health Insurance
• Third Party Administrator (TPA)
• Hospital Insurance Desk
• Medical Claims Adjudication
• Clinical Documentation Review

Salary & Benefits

• Competitive salary based on experience.
• Performance-based incentives.
• Career growth opportunities in the healthcare insurance domain.
• Training and professional development

Pay: ₹20,261.96 - ₹36,646.61 per month

Benefits:

• Flexible schedule
• Health insurance
• Work from home

Work Location: Hybrid remote in Naya Raipur, Raipur, Chhattisgarh