04 Sep
|
Vidal Health Insurance TPA
|
Bengaluru
04 Sep
Vidal Health Insurance TPA
Bengaluru
.
Key Responsibilities:
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:
Solid knowledge of TPA/Health Insurance claims and pre-authorization processes.
Positive understanding of medical terminology and claim documentation.
Analytical skills with solid 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