Tpa Medical Officer jobs

Job Description – Medical Officer (MO)

Position: Medical Officer (MO)
Department: Medical / Claims Processing
Location: Ranchi, Jharkhand
Number of Openings: 5
Employment Type: Full-Time
Experience: 0–5+ Years
Qualification: BAMS / BHMS / BDS
Registration: Valid State/National Medical Council registration is mandatory

Key Responsibilities

• Review and assess medical claims and related patient/hospital documents.
• Verify diagnosis, treatment details, medical records, prescriptions, investigation reports, and bills.
• Evaluate the medical necessity and appropriateness of treatment as per applicable guidelines and policies.
• Scrutinize pre-authorization and reimbursement claims.
• Identify discrepancies, missing documents, inconsistencies, or potential fraud indicators in claims.
• Coordinate with hospitals and internal teams for clarification and additional medical documents.
• Provide medical opinions and recommendations on claim admissibility.
• Ensure timely processing of assigned claims while maintaining accuracy and quality.
• Maintain proper documentation and records of claim assessments.
• Follow company SOPs, medical guidelines, and applicable regulatory requirements.
• Support the team in meeting defined productivity, quality, and turnaround-time (TAT) targets.

Pay: ₹20,813.87 - ₹37,171.55 per month

Work Location: Remote