Claims Operations

Website: healthassisttpa.com
Job details:

Job Title: Senior Medical Officer (TPA)

Experience: Minimum 5+ Years (Mandatory in TPA / Health Insurance)

Location: Janakpuri West, New Delhi

Job Description:

We are seeking a highly experienced Senior Medical Officer with strong knowledge of TPA operations and health insurance processes to handle medical claims, audits, and coordination.

Key Responsibilities:

• Review and process cashless & reimbursement claims as per policy terms
• Perform medical scrutiny and audit of claims
• Handle pre-authorization approvals/rejections
• Coordinate with hospitals and internal teams for smooth operations
• Address queries and grievances from insured members and providers
• Ensure compliance with TPA protocols and IRDAI guidelines
• Support in fraud detection and investigation cases
• Maintain accurate medical records and documentation

Required Skills:

• Strong understanding of TPA & health insurance processes
• Good analytical and decision-making skills
• Excellent communication and coordination abilities
• Ability to manage workload and meet deadlines

Qualification:

• BHMS / BAMS / BDS (Mandatory)
• Relevant experience in TPA / Insurance sector preferred

Key Requirement:

• Minimum 5+ years of experience in TPA / Health Insurance is strictly mandatory

Click on Apply to know more.