JOB DESRCIPTION The role involves auditing claims and preauthorization to ensure clinical appropriateness policy compliance and correct system processing It requires a strong blend of medical understanding and system knowledge to identify errors investigate their root causes and support in improvement of workflows Key Responsibilities 1 Review claims and pre-auths processed to ensure accuracy in clinical decision-making and alignment with policy guidelines 2 Audit system-generated outcomes to verify that automation logic supports correct and compliant decisions 3 Identify deviations mismatches or logic failures that impact outcomes 1 Analyze audit findings to determine whether issues stem from clinical misjudgment system configuration or data input errors 2 Document root causes clearly and escalate cases where system logic correction or process improvement is needed 3 Monitor recurring issues and contribute to preventive solutions 1 Understand rules engines logic flows and automation triggers used in claims and preauth systems 2 Validate logic changes before implementation by reviewing test cases and outcomes 3 Provide feedback to improve system accuracy and minimize manual overrides 1 Work closely with internal teams including medical product IT and claims to align on audit findings and corrective actions 2 Share insights and support knowledge transfer based on audit observations 1 Maintain structured records of audit findings types of errors financial or process impact and resolution steps 2 Contribute inputs to audit dashboards and reporting tools for internal performance tracking and process evaluation Job Type Full-time Pay 20 000 00 - 30 000 00 per month Perks Health insurance Provident Fund Work Location In person

📌 Medical Audit Officer (Karnataka)
🏢 Vidal Health Tpa Private
📍 Karnataka