Medical Claims Vetting Officer

Role Overview

We are looking for healthcare professionals to join our claims team as Medical Claims Vettors. The role involves reviewing and assessing medical claims to ensure accuracy, appropriateness, and compliance with insurance policies and clinical standards.

Key Responsibilities

* Review and vet medical claims for accuracy, completeness, and eligibility

* Assess diagnosis, procedures, and prescribed treatments for medical necessity

* Detect fraudulent, exaggerated, or inappropriate claims

* Ensure claims align with policy coverage and clinical guidelines

* Liaise with healthcare providers for clarification when needed

* Recommend approval, adjustment, or rejection of claims

* Maintain accurate documentation and records of claims decisions

* Support cost-containment and fraud prevention initiatives

Requirements

* Degree in Medicine (MBChB/MBBS) or Pharmacy (BPharm/PharmD)

* 1–3 years of clinical experience post internship/housemanship

* Understanding of clinical care pathways and treatment protocols

* Strong attention to detail and analytical skills

* Ability to interpret medical records and billing information

* Good communication and negotiation skills

* Familiarity with health insurance processes is an added advantage

Key Competencies

* Clinical knowledge application

* Decision-making and judgment

* Integrity and professionalism

* Attention to detail

* Time management

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