Consultant - Adjudication Auditor SPE - NHA (ABDM)

Roles and Responsibilities

About NHA:

National Health Authority (NHA):

NHA is the apex body responsible for implementing Indias flagship public health insurance/assurance scheme called Ayushman Bharat Pradhan Mantri Jan Arogya Yojana” & has been entrusted with the role of designing strategy, building technological infrastructure and implementation of “National Digital Health Mission” to create a National Digital Health Eco-system. National Health Authority is the successor of the National Health Agency, which was functioning as a registered society since 23rd May, 2018.NHA is governed by a Governing Board chaired by the Union Minister for Health and Family Welfare.

About Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (AB PM-JAY):

The Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (AB PM-JAY) aims to to achieve the vision of Universal Health Coverage (UHC). This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to "leave no one behind."

PM-JAY was announced by the Hon’ble Prime Minister on 23rd September, 2018. It is currently being implemented in 36 States/UT’s.

Candidates may find more details at: https://pmjay.gov.in

Required Profile:

Essential: Medical Graduate

Desirable: MBBS

Experience: Essential: 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"

Roles & Responsibilities:

(1) Create and strengthen claims audit tools and modules to enable the conduct of effective desk and field claims audits;
(2) Conduct claims audits;
(3) Analyse various dashboards, triggers and outliers to identify cases for claims audits;
(4) Prepare weekly, monthly and yearly reports, as and when required;
(5) Prepare and share reports indicating suggested corrective actions;
(6) Any other assignmenU responsibility given by NHA.