Medical Officer - Scrutiny Department

Medical scrutiny of reimbursement claims
Proper scrutiny of medical documents received from the hospital/ patient and ask for relevant details to corroborate with the available diagnosis.
Review the treatment details/ medication regimen given during hospitalization and ask for justification from treating doctor if treatment protocol is not appropriate to the diagnosis
Collate the medical details with the applicable policy terms to arrive at the final decision of claims adjudication.
To resolve employees/claimants medical queries