Skip to main content
Upload your CV and find your next job on Indeed!

Medical Claims jobs

Sort by: -
    • Strong understanding of medical documentation and claims review standards.
    • This is a corporate role focused on medical claims review, pre-authorization, and…
    • Knowledge of medical terminology, billing codes, and medical records management preferred.
    • Previous experience in a medical assistant, medical office, or…
  • View similar jobs with this employer
    • Strong medical science knowledge to comprehend medical reports.
    • Key Skills: Ability to review and analyze complex medical documentation with a high degree of…
    • Forward high cost amount claims to the medical team for evaluation.
    • Optional Experience: Previous experience in medical insurance.
    • Experienced on medical billing/ AR Collections.
    • Ability to identify and correct medical billing errors.
    • Background in calling insurance (Payer) to verify claim…
    • Process patient billing information and submit insurance claims.
    • Work with US insurance portals for claim status and follow-ups.
    • 100% Remote (Work from Home).
    • Interact professionally with other business units to gather and analyze data needed to properly adjudicate claims and documentation of claims files.
    • Perform claim reviews with focus on coding and billing errors.
    • Provides clinical review expertise for high dollar and complex claims, including facility and…
  • View similar jobs with this employer
    • Understanding of claim life cycle.
    • Be able to understand and apply plan concepts to include:
    • Recognize issues related to variable deductible, coordination of…
    • 1-2 years in US healthcare medical claim & insurance-related domain ders.
    • Strong knowledge of US medical claims processing & US healthcare system Strong…
    • This position provides back-office support to the claims operations by performing accurate data entry, document management, and routine reporting while ensuring…
    • Simplify complex medical information into concise summaries that can be understood by both medical and non-medical audiences.
    • Verification of the claim documents.
    • Follow up for the claim documents.
    • Managing the escalation related to claims.
    • Explaining the claim query to the employee.
    • Review materials, proofread, and check medical content/claims against references.
    • Work collaboratively with other cross-functional medical and scientific…
    • Collaborate with internal teams, including billing, coding, and compliance, to ensure accurate and compliant claim submissions.
    • 2 years of related experience.

People also searched:

fresher
health insurance
healthcare
hospital
insurance
insurance claims
medical coding
medical officer
medical representative
medical scribe

Job Post Details

Medical Officer – TPA & Claims Review - job post

Immabeme Solutions Pvt Ltd
Noida, Uttar Pradesh
Up to ₹8,00,000 a year

Job details

Pay

  • Up to ₹8,00,000 a year

Job type

  • Permanent
  • Full-time

Location

Noida, Uttar Pradesh

Benefits

Pulled from the full job description

  • Health insurance
  • Paid time off
  • Life insurance

Full job description

ABOUT THE ROLE

--------------

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

--------------------

  • 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

--------------------------------

  • 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

--------------------

  • 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

--------

  • 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

-----------

  • 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

Let Employers Find YouUpload Your Resume