Mbbs Doctor

Location: Gurgaon,Udhyog Vihar Phase 5

Role- Medical Officer in Risk and Audit

Key Responsibilities

• Risk management: Identify, assess, and mitigate operational and compliance risks across TPA functions.
• Reply on Insurer`s queries in paid claims .
• To prove all the payment recommended by our company justified to minimize / save recovery which has to be paid at the end by our company to insurer.
• There is also need of communication with hospitals , where there are tertiary care hospitals pan India also .
• Audit planning: Develop and execute internal audit schedules covering claims, insurer coordination, and data processing.
• Compliance monitoring: Ensure adherence to IRDAI guidelines, contractual obligations, and internal SOPs.
• Process improvement: Recommend corrective actions and streamline workflows based on audit findings.

• Reporting: Prepare detailed MIS reports, risk dashboards, and audit summaries for leadership review.

• Stakeholder engagement: Collaborate with insurers, medical officers, Hospital and operations teams to resolve escalations.

• Team leadership: Supervise auditors/processors, provide training, and ensure performance standards are met.

Required Skills

• BAMS/BDS/BUMS/BHMS/MBBS with Strong knowledge of health insurance policies, TPA processes, and regulatory frameworks.
• Expertise in risk assessment, internal audit methodologies, and compliance management.
• Proficiency in MS Excel, MIS reporting, and documentation.
• Analytical mindset with attention to detail and problem-solving ability.
• Excellent communication and stakeholder management skills.

Experience

• Minimum 1-5 years of experience in audit, risk, or compliance roles within the TPA/health insurance industry.
• Prior experience in leading audit teams and handling insurer/TPA escalations is preferred.

Experienced candidate should be from TPA or Health Insurance Industry

Kindly connect if you are interested on whats app or call-[phone removed]