Senior Consultant - Forensics - National - ASU - Forensics - Investigations & Compliance - Gurgaon

About the role

Senior Consultant-National-Forensics-ASU - Forensics - Investigations & Compliance - Gurgaon National comprises of sector agnostic teams working across industries for a well rounded experience. ASU - Forensics - Investigations & Compliance : Successful organizations depend on their reputation for keeping promises, respecting laws and behaving ethically to maintain stakeholder trust.

What you'll do

• Conduct desk-based medical audits and reviews of claims submitted under government healthcare schemes
• Identify indicators of fraud, waste, and abuse, including inappropriate billing, medically unnecessary procedures, documentation inconsistencies, duplicate claims
• Support development, refinement, and validation of fraud detection triggers, business rules, and control mechanisms
• Assess the clinical appropriateness of diagnoses, procedures, admissions, investigations, and length of stay against established treatment protocols and scheme guidelines
• Provide clinical insights and technical support to strengthen claims adjudication and fraud management processes

What you need

• Compliance
• Claims processing
• Audit
• Capital markets
• SAP
• Google Analytics
• MBBS