Assistant Manager - Claims Doctor

Rozeegpt · Karachi division, Pakistan

FULL TIMEPKR90 – PKR130 / yr

Job Description

EFU Life Assurance Ltd. seeks a diligent and knowledgeable Assistant Manager - Claims Doctor to join our medical claims team. The ideal candidate holds an MBBS qualification and possesses at least two years of experience, preferably in medical claims or insurance. This role demands profound expertise in medical terminology, medical coding including ICD-10, and clinical documentation review to ensure accurate evaluation of medical claims. The professional in this position works independently, demonstrating strong analytical and decision-making skills to assess medical documents thoroughly and make informed decisions that align with company policies and medical standards.The Assistant Manager - Claims Doctor plays a critical role in enhancing the claims processing workflow by meticulously verifying clinical details of submitted claims against insurance policies and medical protocols. This position requires a detail-oriented individual with the capability to interpret complex medical records and coding systems. While this role does not involve managing a team, it requires effective collaboration with internal departments to support the claims adjudication process and ensure compliance with regulatory and organizational guidelines.

Responsibilities

Review and analyze medical claims to verify accuracy and validity based on medical documentation and insurance policy terms.
Assess clinical documentation and medical coding, including ICD-10, to ensure compliance with established medical and insurance standards.
Evaluate the medical necessity and appropriateness of treatments and procedures claimed, ensuring alignment with medical guidelines.
Interpret medical terminology and clinical reports for accurate claims review and resolution.
Collaborate with claims processing teams to clarify medical information and resolve discrepancies.
Provide expert advice on complex medical claims issues and contribute to improving claims adjudication processes.
Ensure claims assessments are thorough, accurate, and completed within designated timeframes.
Maintain up-to-date knowledge of medical coding standards and insurance policies relevant to claims evaluation.
Support compliance efforts by adhering to legal, regulatory, and ethical standards in claims review.
Prepare detailed reports and documentation related to claim assessments and decisions.

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Company	Rozeegpt
Location	Karachi division, Pakistan
Type	FULL TIME
Niche	finance
Salary	PKR90 – PKR130 / yr

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Assistant Manager - Claims Doctor

Job Description

Responsibilities