Dear Candidate,

Greetings from Phoenix Assurance Private Limited!

Phoenix Assurance Private Limited, in partnership with Althabil Health Insurance, is looking for qualified and experienced medical professionals for the position of Health Insurance Claim Auditor at the Althabil Health Insurance office in Begumpet, Hyderabad.

We are seeking candidates with a strong medical background, sound knowledge of health insurance claims, and excellent analytical skills to support our claim audit operations.

Position Details

Particulars| Details

Position| Health Insurance Claim Auditor

Organisation| Phoenix Assurance Private Limited, in partnership with Aditya birla Health Insurance

Work Location| Aditya birla Health Insurance Office, Begumpet, Hyderabad

Salary Range| ₹35,000 – ₹50,000 per month

Educational Qualification| BHMS, BAMS, BPT, MBBS, BDS

Experience Preference| Medical and Health Insurance Claims

Background

Joining| Immediate

Working Days| As per Aditya birla health Insurance company policy

Working Hours| As per Aditya birlaHealth Insurance office timings

Key Job Responsibilities The selected candidates will be responsible for conducting quality audits of health insurance claims processed by Third-Party Administrator (TPA) companies.

The primary objective of the role is to identify errors, discrepancies, and process gaps in claim assessment and determine whether such errors have occurred at the claim processing level or during medical scrutiny.

The key responsibilities include

- Claim Audit & Quality Assessment: Review health insurance claims processed by TPAs to assess the accuracy and quality of claim decisions.
- Identification of Processing Errors: Identify errors related to policy interpretation,



documentation, benefit applicability, claim calculations, and processing guidelines.
- Medical Scrutiny Audit: Evaluate the quality of medical assessment, including medical justification, diagnosis, treatment appropriateness, and admissibility.
- Analytical Review: Analyse claim data to identify recurring errors, trends, deviations, and areas requiring corrective action.
- Root Cause Analysis: Differentiate between errors arising at the operational processing level and those arising during medical scrutiny.
- Quality Improvement: Provide audit observations and actionable recommendations to improve claim processing accuracy, consistency, and efficiency.

Desired Candidate Profile

- Qualified medical professionals with BHMS, BAMS, BPT, MBBS, or BDS degrees.
- Candidates with experience in health insurance claims, medical scrutiny, TPA operations, or claim auditing will be preferred.
- Strong understanding of health insurance policies, claim processing procedures, and medical assessment.
- Excellent analytical skills and the ability to interpret claim data.
- Solid attention to detail and the ability to identify discrepancies and process deficiencies.
- Immediate joiners will be preferred.

Compensation The salary budget for this position is ₹35,000 to ₹50,000 per month, depending on the candidate's qualifications, experience, and suitability for the role.

Application

Interested candidates are requested to share their updated CV for consideration.

Email - [email protected]

We look forward to welcoming qualified medical professionals to our team.

Best Regards,

HR Department

Phoenix Assurance Private Limited In Partnership with Aditya birla Health Insurance

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