RC
Medical Adjudicator
RAPS Consulting - India
🇮🇳 India
On-site
4 months ago
- medical terminology
- Health insurance
4 months ago
Not enough detail in this posting to match
Responsible for evaluating and processing medical insurance claims accurately as per policy terms, medical protocols, and company guidelines.
Key Responsibilities
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Review and process OPD/IPD claims as per policy terms and SOPs
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Validate medical necessity, exclusions, co-pay, and documentation
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Coordinate with hospitals, providers, and internal teams for claim resolution
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Ensure claim accuracy, TAT adherence, and IRDAI compliance
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Maintain claim records, audit trails, and reports
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Travel to Neyveli once a month for client meetings and discussions
Required Skills
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Strong understanding of health insurance claims and medical terminology
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Good analytical ability and attention to detail
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Strong communication and coordination skills
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Knowledge of TPA systems and claim processes preferred
Preferred Qualifications
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Any AYUSH Doctor (BAMS / BHMS / BUMS / BNYS)
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1+ years of experience in health claims adjudication with TPA/Insurance industry
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Experience handling corporate and retail health insurance claims
Why Join Us?
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Opportunity to work with leading corporate clients
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Career growth in health insurance domain
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Collaborative and professional work environment
Medical Adjudicator · RAPS Consulting - India