Clinical Operations Executive – BDS/BHMS/BAMS

EASE PRO PVT LTD · Lucknow

Pay₹20,000–25,000a month, as listed

WhereLucknowUttar Pradesh

TypeFull time

Posted10 Oct9 days ago, via SimplyHired

Kaam checked

No fee, deposit or pay-to-apply signs

Day work

No vehicle or licence needed

Skills they list20 named

BHMSCollaborate with healthcare professionalsHealth insurance authorisationsMedical claims processingUtilization reviewOperations coordinationClient enquiry handlingInternal team coordination for query resolutionCustomer enquiry handlingBDSUtilization managementCompliance documentationClinical documentationMedical billingDocumentation handlingBAMSClaims coordination proceduresInternal team coordination for issue resolutionTeam coordinationMultidisciplinary team collaboration

About this job

Review and assess TPA/insurance cases for medical necessity and policy compliance.

Verify diagnosis, treatment plans, investigations, and hospitalization requirements.

Coordinate with doctors, nursing, billing, and TPA/insurance teams for smooth case processing.

Handle pre-authorizations, queries, extensions, and final approvals from TPAs.

Ensure accurate and timely submission of medical documents and case summaries.

Review discharge summaries and bills for clinical justification and completeness.

Resolve TPA queries and support timely claim processing and settlement.

Maintain proper documentation and ensure compliance with hospital and TPA protocols.

Pay: ₹20,000.00 - ₹25,000.00 per month

Benefits

Flexible schedule

Paid sick time

Provident Fund

Work Location: In person

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