Job Description
- Job Description:
- Review medical records, treatment plans, and billing documents for medical necessity and coding accuracy.
- Validate if clinical documentation supports prescribed procedures or medications.
- Prepare concise medical justifications for approval, denial, or modification of claims.
- Identify potential fraud, abuse, or errors in medical claims.
- Respond to query letters from insurers or legal teams within defined turnaround times.
- Maintain strict confidentiality of patient and provider data.
- Use internal web-based review platforms (training provided).
- Requirements:
- Education: MBBS, MD, BDS, BAMS, BHMS, PharmD, or equivalent
- License: Active registration with a recognized medical/dental council
- Experience: 0–3 years (freshers can apply; training provided)
- Technical: Basic computer skills; familiarity with MS Office or Google Workspace
- Soft Skills: Attention to detail, analytical thinking, written English proficiency
- Benefits:
- Flexible work arrangements
- Monthly payment via bank transfer / PayPal