Clinical Reviewer (Current) - RedRoad Health Solutions Pvt. Ltd. - Bengaluru, Karnataka
(2024-01 - 2026-02)
- Review clinical documents and medical records for accuracy, completeness, and compliance.
- Evaluate medical necessity based on clinical guidelines and standard treatment protocols.
- Analyze diagnoses, investigations, treatment plans, and hospital records.
- Support utilization management and clinical decision-making processes.
- Coordinate with physicians and healthcare providers to obtain additional clinical information when required.
- Ensure quality, confidentiality, and timely completion of clinical reviews.
- Maintain accurate documentation while adhering to company policies and healthcare regulations.
Medical Officer - Medi Assist - Tower D, 4th Floor, IBC Knowledge Park, 4/1 Bannerghatta Road, Bangalore - 560029
(2019-01 - 2024-12)
- Processed health insurance claims within the defined turnaround time (TAT).
- Reviewed medical records, diagnoses, and treatment details.
- Verified policy terms and supporting documents.
- Approved or rejected claims based on insurance guidelines.
- Raised insufficiency requests (IR) whenever required.
- Ensured compliance with company policies and quality standards.
Claim Adjudicator - UTI Infrastructure Technology & Services Ltd.
(2017-01 - 2018-12)
- Evaluated health insurance claims.
- Verified medical documents and policy coverage.
- Processed claims accurately within turnaround time.
- Coordinated with internal teams for claim resolution.
Staff Nurse - Baby Memorial Hospital - Kozhikode, Kerala
(2015-01 - 2016-12)
Clinical Responsibilities
- Delivered direct patient care.
- Administered medications and treatments.
- Assisted with admissions, discharges, and patient transfers.
- Maintained accurate nursing documentation.
- Educated patients and their families.
- Collaborated with multidisciplinary healthcare teams.
- Worked in General Practice and Obstetrics & Gynecology departments.
