Role Description
This role is responsible for driving ISO 9001-compliant internal audit practices across healthcare claims operations at CHSI Bangalore. The incumbent will ensure adherence to Quality Management Systems (QMS), strengthen operational controls, and enable a culture of continuous improvement, compliance, and audit readiness.
Key Responsibilities
ISO Audit & Compliance
Plan and execute internal audits aligned to ISO 9001:2015 (Clause 9.2) and ISO 9001:2026
Conduct process audits across the end-to-end claims lifecycle (intake → adjudication → payment → appeals)
Perform gap assessments to evaluate compliance against QMS standards
Ensure robust audit documentation, evidence validation, and traceability
Claims Process Oversight
Assess claims accuracy, turnaround time (TAT), and policy adherence
Audit critical processes, including:
Claims adjudication
Eligibility & enrolment validation
Denials & appeals management
Identify process inefficiencies, control gaps, and operational risks
CAPA & Continuous Improvement
Drive Corrective and Preventive Actions (CAPA)
for audit findings
Track closure of findings with quantifiable outcomes and timelines
Partner with operations to standardize processes and drive quality improvements
Stakeholder Engagement
Collaborate with:
Operations leadership
Quality assurance teams
Training and transition stakeholders
Support external certification audits and regulatory reviews
Develop audit reports, insights, and executive-ready summaries
Governance & Reporting
Manage audit calendars, trackers, and compliance dashboards
Publish insights on defect trends, risk indicators, and audit outcomes
Support Management Review Meetings (MRMs) and governance forums
Candidate Profile
Education & Certifications
Graduate (mandatory)
Preferred certifications:
ISO 9001 Internal Auditor / Lead Auditor
Six Sigma Green Belt (or equivalent)
Experience
5–10 years of relevant experience in:
Healthcare BPO / US/International healthcare claims operations
Quali