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Claims Auditor - BPA

smartdata solutions

Chennai, Tamil Nadu, India

Posted on Jul 23, 2026

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Claims Auditor

Smart Data Solutions, a leading provider of data management, claim routing and workflow solutions to health plans and TPAs, is looking for a Claims Auditor to join our team

What you’ll be doing?
Plan and perform audits of enrollment, eligibility, claims processing, and other operational areas for accuracy, timeliness, and compliance with regulatory and contractual requirements.
Develop and maintain audit work plans, checklists, sampling methodologies, and audit schedules.
Review case files, transactions, and system records to verify adherence to state and federal healthcare regulations (e.g., Medicaid, Medicare, ACA) and applicable accreditation standards.
Document audit findings, root causes, and risk levels in explicit, well-organized audit reports.
Present audit results to management and collaborate with department leaders on corrective action plans.




Track and follow up on corrective action items to confirm timely remediation and closure.
Support internal audits, as needed.
Maintain audit documentation in accordance with organizational retention and confidentiality requirements.
Identify trends and systemic issues across audit results and recommend process improvements.
Serve as an escalation point for claims that cannot be resolved by processors, ensuring accurate and timely resolution.
Process claims directly on an occasional basis (e.g., during ramp-up/ramp-down periods, backlog reduction, or urgent processing needs), applying the same standards of accuracy and timeliness expected of examining staff.
Participate in departmental and client training and calibration meetings as needed to maintain consistency between audit and processing standards.
Ensure compliance with all client requirements, regulatory guidelines, and internal policies, including HIPAA.
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📌 Claims Auditor Chennai (India)
🏢 The Blue Venture Fund
📍 India