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