Posted 25 May, 2026
Medical Adjudicator
RAPS Consulting - India
Chennai, IN
Full Time
Reference: 26-00105-2176-1
Job Summary
Responsible for evaluating and processing medical insurance claims accurately as per policy terms, medical protocols, and company guidelines.
Key Responsibilities
•
Review and process OPD/IPD claims as per policy terms and SOPs
•
Validate medical necessity, exclusions, co-pay, and documentation
•
Coordinate with hospitals, providers, and internal teams for claim resolution
•
Ensure claim accuracy, TAT adherence, and IRDAI compliance
•
Maintain claim records, audit trails, and reports
•
Travel to Neyveli once a month for client meetings and discussions
Required Skills
•
Strong understanding of health insurance claims and medical terminology
•
Good analytical ability and attention to detail
•
Strong communication and coordination skills
•
Knowledge of TPA systems and claim processes preferred
Preferred Qualifications
•
Any AYUSH Doctor (BAMS / BHMS / BUMS / BNYS)
•
1+ years of experience in health claims adjudication with TPA/Insurance industry
•
Experience handling corporate and retail health insurance claims
Why Join Us?
•
Opportunity to work with leading corporate clients
•
Career growth in health insurance domain
•
Collaborative and professional work environment
Responsible for evaluating and processing medical insurance claims accurately as per policy terms, medical protocols, and company guidelines.
Key Responsibilities
•
Review and process OPD/IPD claims as per policy terms and SOPs
•
Validate medical necessity, exclusions, co-pay, and documentation
•
Coordinate with hospitals, providers, and internal teams for claim resolution
•
Ensure claim accuracy, TAT adherence, and IRDAI compliance
•
Maintain claim records, audit trails, and reports
•
Travel to Neyveli once a month for client meetings and discussions
Required Skills
•
Strong understanding of health insurance claims and medical terminology
•
Good analytical ability and attention to detail
•
Strong communication and coordination skills
•
Knowledge of TPA systems and claim processes preferred
Preferred Qualifications
•
Any AYUSH Doctor (BAMS / BHMS / BUMS / BNYS)
•
1+ years of experience in health claims adjudication with TPA/Insurance industry
•
Experience handling corporate and retail health insurance claims
Why Join Us?
•
Opportunity to work with leading corporate clients
•
Career growth in health insurance domain
•
Collaborative and professional work environment
