Medical Claim Officer
23 hours ago
Job Requirements:
- Education: A-Pharmacy, B-Pharmacy, Dispensary Clinical Assistant degree from a recognized university.
- Experience: Minimum 3–4 years of relevant experience in medical field claim verification, hospital administration, or insurance medical review.
- Knowledge:
- Familiarity with corporate health insurance policies and medical claim processes.
- Strong understanding of OPD procedures, medications, and diagnostics.
Key Responsibilities:
- Review and verify all OPD medical claims submitted by employees.
- Assess the medical necessity and validity of treatments, prescriptions, and investigations.
- Cross-check the submitted bills, consultation slips, and reports against the prescribed treatment.
- Approval of verify claims on SAP.
- Ensure all claims are in line with company medical policy and insurance terms.
- Identify and highlight any discrepancies, ineligible expenses, or fraudulent claims.
- Coordinate with the insurance provider (IGI) for clarification or additional verification when required.
- Provide proper information to employees regarding claim approvals, rejections & deductions.
- Manage queries of employees via MS. Teams & Emails.
- Maintain accurate records and ensure timely processing of verified claims.
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