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Medical Evaluation Specialist

Dinoxo Verified employer

Actively hiring · Posted 8d ago · JEV260951FFE54F53

SalarySalary not disclosed
Experience5–10 yrs
LocationBengaluru, Bangalore, Karnataka
Work modeRemote · Full time
Openings1
EducationAny Graduate - Any Specialization, Any Post Graduate - Any Specialization, Any Doctorate - Any Specialization
Shift9am-6pm
IndustryMEDICAL / HEALTHCARE / HOSPITALS
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Job description

Review and evaluate health insurance claims using medical records, clinical protocols, and policy guidelines. Prepare evidence-based medical justifications and support claim appeals and reconsiderations. Analyze medical documentation, identify assessment errors, and prepare detailed review reports. Coordinate with insurance companies, TPAs, hospitals, and physicians for claim resolution. Ensure compliance with healthcare regulations, insurance policies, and quality standards.

Responsibilities

, Medical Officer, Medical Officer, Medical Officer

Key skills

Medical ClaimsHealth InsuranceClaims AdjudicationMedical EvaluationClinical ReviewMedical AuditUtilization ReviewInsurance ClaimsMedical DocumentationClinical Documentation ReviewMedical Records AnalysisMedical Necessity AssessmentHealth Insurance Claims

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