- Review and audit pre-authorization and claims to identify risks, errors, and potential fraud.
- Validate medical records, treatment details, bills, and claim documentation.
- Identify deviations, policy/process violations, and suspicious claim patterns.
- Conduct clinical and claims audits and recommend corrective actions.
- Coordinate with medical, claims, and operations teams for query resolution.
- Prepare audit reports, highlight risk areas, and track closure of observations.
- Support process improvement initiatives to reduce financial and operational risks.
Key Skills:
- Strong knowledge of TPA/Health Insurance claims and pre-authorization processes.
- Valuable understanding of medical terminology and claim documentation.
- Analytical skills with strong attention to detail.
- Experience in risk identification, audit and fraud detection.
- Good communication and report-writing skills.
📌 Manager - Risk and Audit (Bengaluru)
🏢 Vidal Health Insurance TPA
📍 Bengaluru
Reply to this offer
Impress this employer describing Your skills and abilities, fill out the form below and leave Your personal touch in the presentation letter.