Health Insurance Claims Quality Auditor

About the role

The role involves reviewing claim assessments, validating medical documentation, identifying discrepancies, and ensuring adherence to policy terms, medical guidelines, internal quality standards, and established claims processing protocols.

What you'll do

• Review claim documents, medical reports, hospital bills, and supporting records to ensure accuracy and completeness
• Verify that claims are processed in accordance with policy terms, medical guidelines, and TPA protocols
• Identify errors, discrepancies, and deviations in claim processing and recommend appropriate corrective actions
• Validate the medical justification for treatments, procedures, and hospitalization expenses
• Ensure compliance with internal quality standards and applicable regulatory guidelines

What you need

• 1–4 yrs of experience
• Insurance
• Quality control
• Claims processing
• MBBS