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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

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