Vidal Health Insurance TPA is looking for Assistnat Manager for Investigation dpt
Location:Gurgaon,Udhyog Vihar Phase 5
Experience: 4-6 Years
Qualifications
- BHMS/BDS/BAMS/BUMS
Role Overview
We are looking for an experienced professional to lead the Investigation function within a Health Insurance TPA environment. The role involves handling suspicious and high-value claims, identifying fraud patterns, and ensuring effective risk control.
Key Responsibilities
- Lead investigation of suspicious and high-value health insurance claims
- Identify fraud patterns (inflated billing, unnecessary hospitalization, document manipulation, etc.)
- Conduct hospital audits and field investigations
- Review medical records, bills, and claim documents for discrepancies
- Coordinate with hospitals, insurers, and internal teams
- Prepare investigation reports with findings and recommendations
- Ensure compliance with IRDAI guidelines and internal processes
- Track MIS, dashboards, and fraud trends
- Manage and guide investigation team members
Key Requirements
- Strong knowledge of health insurance claims (cashless & reimbursement)
- Experience in fraud detection and hospital/provider investigations
- Understanding of medical billing and documentation
- Good analytical and report-writing skills
- Strong stakeholder management skills
Qualifications
- BHMS/BDS/BAMS/BUMS
- 4-6 years of experience in TPA / Health Insurance investigations
Why Join Us
- Chance to work in a critical risk control function
- Exposure to complex and high-impact cases
- Leadership role with team management responsibility