Medical Officer

Job Details

JD ID: LLRI/1226/00

Role : Medical Officer

Location: Bangalore

Purpose of the Role:

To scrutinize and process medical insurance claims within the agreed Turnaround Time (TAT) by understanding policy terms & conditions and applying medical domain knowledge accurately.

Eligibility :

Qualification : BAMS / BHMS/ BDS

Freshers or experienced candidates (as per company criteria)

Strong interest in medical insurance & claims processing

Key Skills Required:

• Medical claims adjudication
• Policy interpretation
• Attention to detail & accuracy
• Analytical and decision-making skills

Technical Skills:

• Medical admissibility check based on diagnosis & treatment
• Claims scrutiny as per insurance *terms & conditions
• Interpretation of ICD coding

Evaluation of:

• Co-pay details
• Room rent capping
• Non-medical expenses
• Package vs open billing
• Understanding difference between PA (Pre-Authorization) and RI (Reimbursement) claims
• Verification of claim documents & raising IR (Information Request) if documents are insufficient
• Approving or denying claims within defined TAT
• Handling escalations & responding to emails

Key Result Areas (KRAs):

• 100% accuracy in claims processing
• Adherence to TAT
• Meeting daily productivity targets

Behavioral & Functional Competencies:

• Strong analytical skills
• Basic computer knowledge
• Typing proficiency
• Clear communication skills
• Sound decision-making ability

Compensation:

• CTC : 3 LPA 3.5 LPA
• Incentives : Performance-based
• Additional Benefit : 40,000 (as applicable)yearly based