Quality Control Executive

We are looking for a Quality Control Executive to review and validate Pre-Policy Medical Examination (PPME) reports prepared for insurance companies. The candidate will be responsible for ensuring that medical reports are accurate, complete, properly documented, and compliant with the requirements of insurance companies before submission.

The role requires strong attention to detail, knowledge of medical investigations and insurance medical documentation, and the ability to coordinate with diagnostic centres, doctors, laboratories, and internal operations teams.

• Key ResponsibilitiesReview Pre-Policy Medical Examination reports for completeness, accuracy, and consistency.
• Verify medical reports against the prescribed insurance company medical formats/MER formats.
• Check reports for:
• Correct patient details
• Age, gender and policy/proposal details
• Medical history and declarations
• Physician/MER examination
• Blood and urine investigation reports
• ECG / TMT
• 2D Echo
• Chest X-ray
• USG / Abdomen & Pelvis
• PFT and other investigations as applicable
• Cross-check laboratory values and investigation results for missing, inconsistent, duplicated, or technically incorrect information.
• Ensure that all required investigations have been completed as per the insurance company's requirements.
• Check that reports contain appropriate doctor signatures, registration numbers, stamps and dates, wherever applicable.
• Identify discrepancies between different sections of the medical report and coordinate with the concerned team for correction.
• Ensure that reports are properly compiled, scanned, uploaded and named as per company/insurer requirements.
• Review reports before final submission to insurance companies, TPAs or underwriting teams.
• Maintain quality-control checklists and daily MIS.
• Track errors, corrections, rework and report rejection reasons.
• Maintain records of QC observations and identify recurring operational errors.
• Coordinate with doctors, diagnostic centres, phlebotomists, laboratories and internal operations teams for timely resolution.
• Ensure compliance with agreed TAT/SLA, generally within the defined reporting timelines.
• Handle urgent and priority cases assigned by the Medical Operations/Underwriting team.
• Maintain strict confidentiality of patient and insurance information.
• Support internal audits and continuous improvement of the medical-reporting process.

Quality Control ParametersThe candidate should be able to identify:

1. Patient Information Errors

• Name mismatch
• Age/date of birth mismatch
• Gender mismatch
• Proposal/policy reference mismatch

2. Investigation Errors

• Missing tests
• Incomplete reports
• Incorrect test names
• Mismatch between test results and summary
• Missing reference ranges/units where required
• Illegible or incomplete reports

3. Medical Examination Documentation

• Missing physician remarks
• Incomplete medical history
• Missing signatures/stamps
• Missing registration details
• Incorrect or incomplete MER

4. Report Compilation

• Correct sequence of documents
• Correct insurer format
• Correct attachments
• Clear and readable reports
• Proper file naming and uploading
• Required SkillsStrong knowledge of medical reports and diagnostic investigations.
• Understanding of insurance medical examination / PPMC processes will be an advantage.
• Good knowledge of MS Excel, Word, email and basic computer applications.
• Strong attention to detail.
• Excellent documentation and coordination skills.
• Ability to identify discrepancies and follow up for corrections.
• Good English communication, both written and verbal.
• Ability to work under deadlines and manage multiple cases simultaneously.
• Good analytical and problem-solving skills.
• Ability to maintain confidentiality of sensitive medical information.
• Preferred QualificationGraduate in Life Sciences / Biotechnology / Microbiology / Healthcare / Medical Laboratory Technology / Nursing or related field.
• Candidates with experience in insurance medicals, diagnostic centres, TPAs, healthcare operations or medical report QC will be preferred.
• Key Performance Indicators (KPIs)Report QC accuracy
• Percentage of reports cleared without rework
• Error/rejection rate
• Report turnaround time
• Timely resolution of discrepancies
• Compliance with insurer-specific formats and requirements
• Daily case productivity
• Accuracy of MIS and documentation

Candidate ProfileThe ideal candidate should be detail-oriented, disciplined and quality-conscious, with the ability to review a high volume of medical reports without compromising accuracy. Experience dealing with insurance companies, underwriting teams, medical examination centres or diagnostic laboratories will be an added advantage.

If you are interested in healthcare operations and have a strong eye for detail, we would like to hear from you.