Consultant Adjudication Auditor- SPE- IITE - NHA(PMJAY) - Delhi

• JD - Consultant Adjudication Auditor- Service Provider Engagement- IITE

Essential: Medical Graduate

Desirable: MBBS

Experience:

Minimum three years of experience in claim processing, claims adjudication and/or audit of health insurance claims.

Desirable:

(i) Experience in health Insurance Eco System preferably with insurer/TPA/Hospitals

(ii) Experience in public health System

• Create and strengthen claims audits tools and modules to enable the conduct of effective desk and filed claims audits.
• Conduct claims audits.
• Analyse various dashboards, triggers and outliers to identify cases for claims audits.
• Preparation weekly, monthly and yearly reports, as and when required.
• Prepare and share reposts indicating suggested corrective actions.
• Nay other assignment/ responsibility given by NHA