Mubasshira Shaikh

Medical Officer I Claims

Role: Medical Officer at Medi Assist
Location: Thane, MH, IN
LinkedIn followers: 500 followers

Healthcare & Human ServicesView LinkedIn profile

About Mubasshira Shaikh

Stepping from the halls of Maharashtra University of Health Sciences with a BAMS degree…

Experience

Medical Officer
Medi Assist
Apr 2025 — Present · Mumbai, IN
Claims Processing:Review and process reimbursement and cashless claims submitted by hospitals or policyholders.Ensure all required documentation is accurate and complete.Validate medical records, prescriptions, diagnostic reports, and invoices.Medical Scrutiny:Assess the medical necessity of treatments and procedures claimed.Check for compliance with policy terms and conditions.Coordinate with medical officers to evaluate complex or high-value claims.Communication & Coordination:Interact with hospitals, insured members, and internal departments for claim clarifications.Respond to queries regarding claim status or documentation requirements.System Updates:Enter claim details in Medi Assist’s claims management system.Ensure all claim updates, approvals, and rejections are recorded systematically.Fraud Detection & Risk Management:Identify discrepancies or potential fraud in submitted claims.Escalate suspicious cases to the investigation team.Policy Adherence:Ensure that claim decisions align with insurance policy guidelines.Stay updated with changing healthcare regulations and insurer protocols.Customer Service:Provide claim-related support to customers and guide them through the claim submission process.Handle grievances and escalate unresolved cases appropriately.Report Generation:Prepare periodic reports related to claim trends, rejections, and processing timelines.

Education

Maharashtra University of Health Sciences
BAMS, Mental Health Counseling/Counselor

Contact information

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Work email
•••••@mediassist.in
Personal email
•••••@•••••.com
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Current company

Medi Assist

Hospitals and Health Care · 4.1K employees · Founded 2002 · Bengaluru, Karnataka, India

We are India’s leading HealthTech and InsurTech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits Administration model is designed to deliver the tools necessary for a health plan to succeed, whether it’s our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members. Our claims analysis blends talent and technology to help our members defy national claim cost trends. We complement internal processing with advanced surveillance software, and once a claim is identified for potential savings, certified medical specialists work through the claim to find cost-saving solutions. Often benefits managers will either point to their provider network discounts as proof of their ability to help grow the bottom line or others will boast of a smaller administration fee, at Medi Assist, benefits management means more than just reducing service fees. Our comprehensive approach to benefits management ensures our members have a positive experience while helping businesses and members keep health care costs low. Our comprehensive approach to benefits management ensures that our members enjoy a positive experience, while we help businesses and members to keep healthcare costs low.

mediassist.in

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