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:
- Healt

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