BHMS/BAMS

Company Description Phoenix Assurance Pvt Ltd is a quality-focused and high-integrity solution and service provider in the insurance industry, specializing in risk management and claim investigation. Established in July 2014, the company delivers investigation services for health, personal accident, and workers compensation claims, as well as audits for government health policies such as PMJAY in western and southern India. Phoenix Assurance also supports government crop insurance programs like PMFBY through manpower supply to various insurance companies, operating across more than nine states. With extensive experience in over one lakh indemnity field claim investigations and seventeen lakh PMJAY investigations, the company serves over 20 clients, primarily insurers and TPAs, and employs a team of more than 600 professionals. Phoenix Assurance has been recognized with multiple prestigious industry awards, reflecting its commitment to long-term client relationships and value-driven risk management solutions.
Role Description This is a full-time, on-site BHMS/BAMS role based in Ahmedabad. The role involves assessing medical records and treatment details for insurance claims, verifying documentation against policy guidelines, and preparing clear, evidence-based medical reports. The professional will collaborate with investigation teams and insurance partners to support accurate claim decisions, help identify patterns in claim frequency and severity, and contribute to loss containment initiatives. Daily responsibilities include field visits when required, maintaining detailed case documentation, adhering to compliance and ethical standards, and participating in continuous improvement of investigation protocols.
Qualifications

• BHMS or BAMS degree from a recognized institution, with valid registration as per relevant medical council or regulatory body.
• Strong knowledge of clinical practices, diagnostic procedures, and treatment protocols relevant to health insurance claim assessment.
• Ability to interpret medical records, prescriptions, diagnostic reports, and hospital documentation with high attention to detail.
• Effective communication skills for coordinating with hospitals, policyholders, field investigators, and internal teams.
• Basic understanding of health insurance processes, claim workflows, and regulatory requirements (experience in PMJAY or similar schemes is an advantage).
• Proficiency in using computers and standard office tools for report writing, data entry, and documentation management.
• Demonstrated integrity, ethical judgment, and ability to handle sensitive medical and personal information confidentially.
• Strong analytical and problem-solving skills, with the ability to work independently and manage multiple cases within timelines.
• Prior experience in claim investigation, medical audit, or insurance-related roles is preferred but not mandatory.