Claim Processor – Medical Claims (MBBS)

Job Title: Claim Processor - Medical Claims (MBBS)

Employment Type: Full-Time

Job Summary

The Claim Processor is responsible for reviewing, evaluating, and processing health insurance claims while ensuring compliance with policy terms, medical guidelines, and regulatory requirements. The role requires strong medical knowledge to assess diagnoses, treatments, procedures, and hospitalizations for claim adjudication.

Key Responsibilities

• Review and assess medical insurance claims for accuracy, completeness, and policy coverage.
• Analyze medical records, discharge summaries, diagnostic reports, prescriptions, and treatment plans.
• Verify the medical necessity and appropriateness of treatments, procedures, and hospital admissions.
• Evaluate claims in accordance with policy terms, clinical guidelines, and company protocols.
• Identify discrepancies, inconsistencies, potential fraud, abu...