Medical Officer Jobs Opening in Medi Asisst TPA Pvt Ltd at Andheri East, Thane, Mumbai
Job Description
Introduction
We are seeking a Medical Officer with expertise in health insurance claim verification and assessment. The candidate will be responsible for evaluating medical claims, ensuring accurate verification of documents, confirming diagnoses and treatment details, and approving or rejecting claims as per the policy terms and conditions (T&C) within the defined Turnaround Time (TAT).
This role requires in-depth medical knowledge, analytical skills, and attention to detail to ensure fair claim settlements and maintain service quality standards.
Key Responsibilities
1. Claim Assessment & Verification
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Review medical claims and assess the medical admissibility based on diagnosis and treatment details.
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Cross-check medical reports, prescriptions, discharge summaries, and investigation results.
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Validate hospital bills, invoices, and supporting documents provided by claimants.
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Ensure all claims comply with policy guidelines and insurance T&C.
2. Documentation & Information Requests
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Verify the completeness and accuracy of submitted claim documents.
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Identify discrepancies or insufficiencies in the provided information.
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Raise information requests to hospitals, doctors, or claimants to obtain missing details.
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Maintain proper claim-related documentation for internal and audit purposes.
3. Approval / Denial of Claims
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Approve eligible claims as per the insurance policy guidelines and T&C.
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Deny or partially approve claims when supporting documents or medical justification are insufficient.
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Clearly document reasons for rejection or partial approval in the system.
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Ensure claim decisions are communicated promptly and transparently.
4. Compliance & TAT Management
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Adhere to the company’s Turnaround Time (TAT) for claims processing.
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Ensure all claim assessments are compliant with IRDAI guidelines and internal policies.
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Escalate high-value or disputed claims to senior management when necessary.
5. Coordination & Stakeholder Management
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Collaborate with insurance operations, customer service, and hospital teams to resolve claim queries.
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Interact with doctors and healthcare providers for clarifications on diagnosis and treatment.
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Provide medical expertise to internal teams for claims dispute resolutions.
Required Skills & Competencies
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Medical Knowledge: Strong understanding of diagnosis, treatments, and clinical procedures.
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Claims Processing Expertise: Knowledge of health insurance claim guidelines and policy terms.
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Analytical Skills: Ability to evaluate medical reports and identify fraudulent claims.
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Attention to Detail: Accuracy in verifying medical documents and financial bills.
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Communication Skills: Ability to explain claim approvals, denials, and pending requests clearly.
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Technical Skills: Familiarity with claims management software and digital documentation.
More information about this Medical Officer Job
Please go through the below FAQs to get all answers related to the given Medical Officer job
- What are the job requirements to apply for this Medical Officer job position?
- Ans: A candidate must have a minimum of 0 to 3+ year experience as an Medical Officer
- What is the qualification for this job?
- Ans: The candidate can be a Graduate from any of the following: B.Pharm, BDS, BSc, MBBS, BAMS, BHMS, BPT
- What is the hiring Process of this job?
- Ans: The hiring process all depends on the company. Normally for an entry level, hiring the candidate has to go for Aptitude, GD (If they look for communication),Technical test and face to face interviews.
- This Medical Officer is a work from home job?
- Ans: No ,its not a Work from Home Job.
- How many job vacancies are opening for the Medical Officer position?
- Ans: There are immediate 1 job openings for Medical Officer in our Organisation.
Job Particulars
About Company
Mumbai 
1 to 3 Years 
Salary not disclosed 
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MBBS, BAMS, BHMS
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1 to 3 Years
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MBBS, BAMS, BHMS
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MBBS, BAMS, BHMS
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MBBS, BAMS, BHMS
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MBBS, BAMS, BHMS
Mumbai, Mumbai Suburbs
2 to 3 Years
Salary not disclosed
BDS
Mumbai
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Salary not disclosed
MD
Mumbai
Freshers
Salary not disclosed
MD 
