Job Description

Hi,

We are Vitraya Technologies Private Limited, an IT product-based company specializing in delivering innovative software solutions to the insurance industry. Given our focus on the insurance sector, we require professionals with a medical background or a strong understanding of medical terminology and procedures.

We invite individuals who have completed medical-related courses such as Nursing BDS, MDS,FDS or an Insurance TPA Background, MBBS and are looking to transition from a clinical setting to a corporate environment.

Role Overview: As part of the team, your primary responsibility will be to authenticate and validate medical documents submitted by hospitals and insurance companies. This includes:

-Ability to analyze medical records, discharge summaries, investigation reports, and correlate with diagnosis & procedures.

-Familiarity with

clinical guidelines

(NABH/WHO/ICMR) to judge medical necessity and appropriateness.

-Understanding of

non-payable items

, exclusions, and standard insurance T&Cs.

-Proficiency in reviewing

tariff structures, SOC (Schedule of Charges), and billing accuracy

.

-Experience in differentiating

OPD vs IPD care

and

day-care vs long-stay admissions

.

-Knowledge of

fraudulent practices

like upcoding, overcharging, and unnecessary procedures.

-Ability to

map procedures and diagnoses with ICD-10 / ICD-11 and PCS coding standards

.

-Awareness of

claim processing workflows

(Pre-auth, Enhancement, Final Claim settlement).

-Strong skills in

decision documentation

- providing clear, evidence-based justifications for approvals/rejections.

-Familiarity with

health schemes and TPAs

(private insurers, AB-PMJAY, state schemes).

-Good computer proficiency - MS Excel, claim portals, and automated adjudication systems.

-Attention to detail with ability to

identify discrepancies in claims quickly

.

-Strong communication skills to interact with hospitals, insurers, and internal teams.

-Team-oriented mindset with ability to work under

tight TAT (Turn Around Time)

.

-Knowledge of

medical abbreviations, short forms, and common documentation practices

used in hospital bills.

Your role will be crucial in ensuring the integrity and accuracy of medical claims, contributing to a streamlined and efficient claims process for our clients.

Job Type: Full-time

Benefits:

Food provided Health insurance Provident Fund
Work Location: In person

Interested Candidates can apply at anup.dobriyal@vitraya.com or WhatsApp their resume at9999043348. Kindly mention "Applying for Medical Officer" while applying on email or sending it to WhatsApp along with your CV attached.

Job Type: Full-time

Pay: ?50,000.00 - ?70,000.00 per month

Benefits:

Food provided Health insurance Provident Fund
Education:

Doctorate (Required)
Work Location: In person