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JOB RESPONSIBILITIES - Applying medical knowledge in evaluating the medical claim files to ascertain the medical admissibility. - Must understand the policy wordings including Terms & conditions to adjudicate the Admissibility/Rejection. - Processing of claims as per regulatory guidelines. - Adhering to the TATs in processing. - Quality review of processed files. - Grievance redressal, handling escalations and identifying the fraudulent claims. CANDIDATE PROFILE: - Qualification must be BAMS, BHMS or BDS - Only BAMS & BHMS freshers will be considered - BDS candidates must have prior health claims processing experience - Candidate must be comfortable with work shifts on roster basis & rotational week-off. .