Medical Officer Jobs at Policybazaar | Medical Professionals Are Welcome!

Are you a healthcare professional looking to apply your expertise in the insurance sector? Medical Officer jobs at Policybazaar for Business offer a unique opportunity to bridge healthcare and insurance, ensuring compliance and quality in medical claims.

About Policybazaar for Business

Policybazaar for Business is a leading organization in the insurance sector, focusing on providing innovative solutions for businesses. Operating in Gurugram, Haryana, the company is committed to enhancing the insurance experience through technology and expert guidance. The organization plays a vital role in the healthcare insurance landscape, ensuring compliance and quality in medical claims and evaluations.

Location: Gurugram, Haryana, India

Responsibilities

• Claims Review and Evaluation:
  • Review medical claims submitted by policyholders to ensure accuracy and compliance with insurance policies.
  • Analyze medical documentation from hospitals and clinics to determine the legitimacy of claims.
  • Assess the medical necessity of procedures and treatments as per insurance policy guidelines.
  • Provide second opinions on disputed claims or complex medical cases.
• Medical Advisory Services:
  • Offer expert advice and medical guidance to the TPA team, insurance providers, and policyholders.
  • Act as a liaison between healthcare providers and the insurance company to streamline the claims process.
• Medical Audits and Reports:
  • Conduct audits to ensure claims accuracy and prevent fraud.
  • Prepare detailed reports on medical claims, risk assessments, and policy compliance for management.
• Collaboration with Medical Providers:
  • Communicate with healthcare providers to clarify medical information and ensure proper documentation.
  • Work with medical professionals on complex treatments or discrepancies in claimed services.

Requirements

• Medical degree (MBBS, MD, or equivalent) from a recognized institution.
• Relevant specialization is a plus (e.g., General Medicine, Surgery).
• Minimum of 5 years of experience in the healthcare industry, ideally in a clinical or insurance-related environment.
• Experience with medical claims evaluation or risk management is highly desirable.
• Familiarity with healthcare laws and insurance policies is advantageous.