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    • The Medical Officer will be responsible for medical assessment and adjudication of health insurance claims, pre-authorization requests, and medical queries.
    • View all Ocean Group jobs - Kaudiar, Kerala jobs - Medical Officer jobs in Kaudiar, Kerala
    • Salary Search: Medical Officer|Health Claims salaries in Kaudiar, Kerala
    • * MBBS degree with valid medical registration.
    • * Handle emergencies and basic medical management when required.
    • * Malayalam and English fluency preferred.
    • Bachelor's degree in Healthcare Management, Business Administration, Hospital Administration, or a related field.
    • Proficiency in MS Office and digital tools.
    • Good clinical and communication skills.
    • Freshers and experienced candidates may apply.
    • Ability to handle medical emergencies efficiently.
    • Respond to all medical emergencies, including Code Blue situations.
    • MBBS from a recognized Medical College.
  • Hiring Resident Medical Officers for our reputed Medical College Hospital. Qualification: MBBS Experience: 0-5 years Interested candidates may apply with…
    • Job Types: Full-time, Permanent.
    • Total work: 1 year (Preferred).
  • kindly share resume to hr@rheumacare.com hr@drshenoycare.com Pay: ₹30,000.00 - ₹50,000.00 per month Work Location: In…
    • Ernakulam, Kerala: Reliably commute or planning to relocate before starting work (Required).
    • Role:- To coordinate with the hospital medical team and insurance…
    • ₹3500 per 12-hour shift.
    • MBBS qualification and higher qualifiactions.
    • Ensures proper admission, discharge of patients with proper paper work.
    • Plans patient care and makes patient assignments as per their nursing needs.
    • Provide emergency medical care when required.
    • Basic knowledge of electronic medical records (EMR) systems.
    • The Medical Officer is responsible for providing…
    • Diagnose and manage common medical conditions.
    • Ability to handle medical emergencies independently.
    • Monitor patient progress and maintain accurate medical…
  • Wanted Resident Medical Officers (MBBS) for a Hospital in Thodupuzha Food and Accommodation provided Malayalam speaking doctors preferred Freshers can also…
    • Degree: Minimum MBBS or equivalent from a recognized medical school.
    • They live on-site or work rotational shifts.

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Job Post Details

Medical Officer|Health Claims - job post

Ocean Group
Kaudiar, Kerala
₹18,000 - ₹20,000 a month

Job details

Pay

  • ₹18,000 - ₹20,000 a month

Job type

  • Contractual / Temporary
  • Freelance
  • Full-time

Location

Kaudiar, Kerala

Benefits

Pulled from the full job description

  • Health insurance

Full job description

Full job description

The Medical Officer will be responsible for medical assessment and adjudication of health insurance claims, pre-authorization requests, and medical queries. The role involves applying clinical knowledge to ensure accurate decision-making, compliance with regulatory guidelines, and prevention of fraud, waste, and abuse in claims processing.

Key Responsibilities

Claims Review & Adjudication
Review and validate pre-authorization and reimbursement claims based on medical necessity, clinical appropriateness, and policy terms.
Assess diagnostic reports, prescriptions, discharge summaries, and medical records for accuracy and completeness.
Ensure claims decisions are aligned with IRDAI regulations and company policy.
Pre-Authorization & Approvals
Evaluate pre-authorization requests within agreed turnaround times.
Liaise with treating doctors/hospitals to seek additional clinical information when required.
Fraud & Abuse Prevention

Identify potential fraudulent or exaggerated claims by analyzing treatment patterns and discrepancies.
Support field investigation teams with medical opinion.
Compliance & Documentation
Maintain accurate, confidential, and complete documentation for all cases handled.
Ensure compliance with industry regulations, ethical standards, and company SOPs.

Qualifications & Skills

Education:BAMS/BDS/BHMS/BYMS/BSMS
Experience: 2–5 years of clinical practice; prior experience in health insurance, TPA, or claims management is an advantage.
Knowledge:
Good understanding of clinical procedures, hospital billing, and ICD coding.
Familiarity with IRDAI guidelines and medical insurance processes.
Skills:
Strong analytical and decision-making skills.
Excellent written and verbal communication.
Ability to work in a fast-paced, process-driven environment.

On site Job.

Job Types: Full-time, Freelance

Pay: ₹18,000.00 - ₹20,000.00 per month

Ability to commute/relocate:

  • Thiruvananthapuram, Kerala: Reliably commute or planning to relocate before starting work (Preferred)

Experience:

  • Claim investigation : 1 year (Preferred)

Work Location: In person

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