01Overview
Exp - 10 plus years,
Work Location - Hyderabad,
Mode of work - Hybrid (3days WFO)
Key ResponsibilitiesMedical Consultation & Case ReviewProvide timely, high-quality medical consultations, including interpretation of diagnostic tests, clinical documentation review, and medical risk assessmentConduct morbidity and mortality reviews to support underwriting and claims-related decisionsReview and analyze attending physician statements, medical records, lab reports, EKGs, stress tests, and other relevant clinical documentationSummarize complex medical records and clinical findings to support downstream decisionmaking by internal and external medical stakeholdersReview approved claim files to assess the ongoing applicability of medical restrictions or limitationsMedical Research & AnalysisConduct research on medical conditions and impairments and their relationship to morbidity and mortalityMaintain current knowledge of relevant medical literature, clinical guidelines, and insurance medicine practicesProvide subject matter expertise for largescale projects, departmental initiatives, and crossfunctional programsTraining & Staff DevelopmentDevelop and deliver medical education and training programs for underwriting, risk management, and claims teamsCoach and support junior or less experienced medical colleagues on case review methodology, clinical reasoning, and documentation standardsProvide ongoing clarification and education through oneonone consultations and group discussionsOperational ResponsibilitiesConduct and/or interpret EKG examinations (where applicable based on qualification and scope of practice)Manage medical referrals based on defined risk thresholds and internal guidelinesSupport BAU (Business As Usual) activities, including:Medical data gathering for teleinterviews and structured health questionnaires (CMI, SHQs, SHS)Review of MIB disclosures and sensitive laboratory resultsSupport for ACLIrelated work and general medical quality assurance activitiesLeadership & CollaborationAct as a Subject Matter Expert (SME) on specialized medical projects and initiativesLead complex problemsolving efforts within the medical team and in collaboration with underwriting, claims, and business partnersContribute to the development, review, and ongoing maintenance of underwriting medical manuals, policies, and clinical guidelinesEligibility & QualificationsMBBS with active license to practice medicineActive or prior registration/licensure with a relevant professional medical or healthcare authority, where applicableDemonstrated ability to analyze, interpret, and apply complex medical and clinical information in a nonpatientfacing, decisionsupport workplaceStrong understanding of medical documentation, diagnostic reports, laboratory data, and clinical narrativesProven capability to assess medical risk, morbidity, and mortality using evidencebased reasoning and available clinical dataExcellent written and verbal communication skills, with the ability to clearly articulate medical opinions to both clinical and nonclinical stakeholdersStrong analytical, critical thinking, and problemsolving abilitiesAbility to work independently, manage complex casework, and contribute to process improvement initiativesDemonstrated aptitude for collaboration, mentorship, and knowledge sharing within multidisciplinary teamsExperience in insurance medicine, underwriting support, claims review, population health, utilization management, clinical audit, or healthcare analytics is preferredWork Location & ScheduleThis role is based out of the Hyderabad office and follows a hybrid working model.
Work schedules and shift timings will be aligned with the reporting Medical Director and Mass Mutual US stakeholders, based on business requirements. .
