: Lead Case Management & Medical Audit

- Location: Bangalore

- Experience: 4–8 Years (Clinical Audit, Medical Case Management, TPA Claims Audit)

- Role Summary: Drive clinical audit processes, review high-value or complex claims, and lead real-time and post-facto price negotiations with provider hospitals to optimize claims spending for partner insurers.

- Key Responsibilities:

- Perform clinical and financial audits on targeted hospital claims to identify billing discrepancies, unbundling, or tariff non-compliance.

- Negotiate directly with hospital management for discounts on high-cost cases, non-tariff procedures, and length-of-stay (LOS) optimizations.

- Establish audit guidelines, medical necessity protocols, and tariff adherence frameworks.

- Collaborate with the insurer's claims processing team to share findings, fraud trends, and cost-containment insights.

- Qualifications & Skills:

- Medical degree (MBBS, BAMS, BHMS) or Master’s in Hospital Administration (MHA) / Public Health (MPH).

- Hands-on experience in medical auditing, utilization review, or claims management in an insurance/TPA setting.

- High medical-legal literacy and strong financial negotiation capability.

Thanks & Regards

Hariprasad

📌 Case Management & Medical Audit - Bangalore (Bengaluru)
🏢 Medi Assist
📍 Bengaluru