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

About the role

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

• Review clinical records, diagnostic reports, treatment documents, and claims data to identify indicators of fraud, waste, and abuse
• Assess the clinical appropriateness of diagnoses, procedures, investigations, admissions, and length of stay against scheme guidelines and accepted clinical standards
• Identify suspicious claim patterns, including unnecessary procedures, inflated billing, duplicate claims, inappropriate admissions, documentation discrepancies
• Support the development, validation, and refinement of technology-enabled anti-fraud solutions, including fraud detection rules, triggers, alerts, and analytics models
• Assist in implementation and continuous strengthening of the scheme's anti-fraud framework across prevention, detection, deterrence, and monitoring functions

What you need

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