Phoenix Assurance Pvt Ltd
Website:
phoenixassurance.in
Job details:
Company Description Phoenix Assurance Pvt Ltd is a specialist service provider in the insurance industry, focused on high-quality, reliable claim investigation and risk management support. Founded in July 2014, the company operates across 9+ states in India, serving over 20 clients, primarily insurance companies and TPAs. Its services span investigation of health, personal accident, and workers’ compensation claims, as well as audits of government health schemes like PMJAY and manpower support for crop insurance programs such as PMFBY. With a team of 600+ employees and extensive experience in more than 18 lakh field claim investigations, Phoenix Assurance has earned multiple prestigious awards. The organization emphasizes integrity, long-term client relationships, and solutions that help contain claim losses.
Role Description The Medical Field Officer – Himachal Pradesh is a full-time, on-site role based in Shimla. The role involves conducting medical field investigations for insurance claims, including visiting hospitals, clinics, and insured individuals to verify medical records, treatment details, and patient condition. The Medical Field Officer will collaborate with physicians and healthcare staff to understand diagnoses, procedures, and treatment plans, and will prepare clear, evidence-based reports for insurance partners. Responsibilities include assessing the appropriateness of patient care and medical documentation, identifying inconsistencies or potential fraud, and ensuring adherence to company and regulatory guidelines. The role also includes providing medical input to internal teams, supporting training initiatives related to medical assessment, and maintaining accurate records in a timely manner.
Qualifications
- Solid knowledge of Medicine and clinical concepts relevant to health and accident insurance claims.
- Experience in Patient Care, including understanding of treatment protocols, patient assessments, and care pathways.
- Ability to collaborate effectively when Working with Physicians and other healthcare professionals to obtain and interpret medical information.
- Familiarity with Surgery and common surgical procedures, with the ability to review and understand operative notes and related records.
- Experience in Training or willingness to support training of field teams on basic medical and documentation standards.
- Recognized medical qualification (e.g., MBBS, BAMS, BHMS, BSc Nursing, or equivalent healthcare degree/diploma).
- Prior experience in medical investigation, health insurance, hospital administration, or clinical practice is an advantage.
- Strong report-writing, documentation, and analytical skills, with attention to detail and integrity in data handling.
- Ability to travel within Himachal Pradesh as required, and to work independently in field conditions.
- Proficiency in basic computer tools (email, MS Office) and comfort using digital reporting platforms.
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