Insurance Claim Auditor/bangalore/doctors

2 weeks ago


Bengaluru, India MediEnsure Pvt Ltd Full time

**Greetings From MediEnsure Pvt Ltd**

**Job Title: Hospital Auditor**

**Qualification-BAMS/BHMS/BDS/BPT/MBA in Healthcare Management/MHA(People with any other healthcare background also can apply)**

**Primary Role**:
As a hospital auditor, the primary role is to evaluate medical claims made by hospitals to ensure that they are medically necessary and accurately billed based on the policies and protocols of the health insurer. They also play a key role in identifying and preventing fraudulent claims by cross-referencing multiple claims and reviewing medical records in detail.

**Responsibilities**:
The primary responsibilities of a hospital auditor are:
1. Conduct audits of medical claims submitted by hospitals to ensure accuracy and appropriateness.

2. Verify the medical necessity of procedures and treatments performed on patients.

3. Identify and report fraudulent billing practices.

4. Evaluate compliance with industry regulations, such as HIPAA and Medicare/Medicaid standards.

5. Analyze medical records to determine if the care provided meets industry standards and best practices.

6. Prepare reports to present audit results to hospital management and health insurer leadership.

7. Communicate with hospital staff and physicians to ensure that they are aware of the audit process and any changes to policies or procedures.

8. Provide support and guidance to hospital staff to help them understand industry regulations and billing practices.

9. Monitor and evaluate trends in claims data to inform policy changes and improve the overall efficiency and effectiveness of the health insurer's operations.

Qualifications:
The qualifications required for a hospital auditor working for a health insurer are:
1. Bachelor's degree in health care management, finance or related field.

2. Knowledge of medical billing codes and insurance industry standards.

3. Ability to read and interpret medical records and claims documents.

4. Experience conducting audits and reviewing financial statements.

5. Excellent analytical skills and attention to detail.

6. Excellent communication skills, both written and verbal.

7. Ability to work independently and within a team environment.

8. Understanding of healthcare industry regulations and quality improvement standards.

9. Proficiency in using computer and data analysis software.

**Job Type**: Contractual / Temporary
Contract length: 12 months

**Salary**: ₹360,000.00 - ₹420,000.00 per year

**Speak with the employer**
+91 8630533811



  • Whitefield, Bengaluru, Karnataka, India Tresbien HR Staffing Full time

    Greetings! Hiring Doctors Medical Officers for Non Clinical Profile (Health Claims) to be processed. Experience - 3 to 5 Years Qualification - MBBS, BDS, BHMS & BAMS Location - Whitefield, Bangalore **Job Description**: - Examining & passing Medical\Health claims of patients. Analysis Reports & processing claims. Final approval of mediclaims. Good...


  • Bengaluru, India Loop Health Full time

    We are looking for a fulltime in office member at our Bangalore Office, who will look after all our paper work when it comes to Claims department. As a claims administrator, you should have attention to details and be up to date with all the documents that are to be procured **Role and Responsibilities**: - Receive Claim Files and add file details as per...


  • Bengaluru, India MEDI ASSIST INSURANCE TPA PRIVATE LIMITED Full time

    **Job description** **Roles and Responsibilities** 01. Involves Processing of Claims ( Preauthorization / Reimbursement claims) 02. Validating and processing these claims within TAT 03. With good communication and medical Knowledge 04. TPA Experience is an added advantage **Financial**: To see to that there is no financial implication for the...

  • Insurance Claims

    3 days ago


    Bengaluru, Karnataka, India Genesis HR Services Full time

    International Voice Process Process - Insurance Claims Require experience in insurance voice process only ( no healthcare exp ) 0 to 3 years experience will work Fresher - 3 LPA For Experience - up to 5.5 LPA 5 working days, 2 days split off working location - Bangalore, Varthur 24*7 Shifts DOJ - 15th May Notice - Only those profiles who can join...


  • Whitefield, Bengaluru, Karnataka, India Tresbien HR Staffing Full time

    Hiring BDS Doctors Freshers (Non Clinical) Experience - 0 to 6 Months (Immediate Joiners) **Location - Whitefield, Bangalore** Company Details - TPA Co. Industry - Insurance (Non Clinical) Qualification - BDS Doctor Job Profile - This is a Non clinical Profile -TPA Claims to be processed. Insurance Claims processing Job. Medical claims, documentation...

  • Claim Processer

    5 days ago


    Bengaluru, Karnataka, India Acko General Insurance Full time

    About UsACKO is a product-tech company, launched in 2016, solving real-world problems for customers, starting with insurance. And as a customer-first organization serving the digitally-savvy, ACKO's value proposition of 'Welcome Change' focuses on offerings that make insurance simple and hassle-free With features such as zero commission, zero paperwork,...

  • Claim Processor

    5 days ago


    Bengaluru, Karnataka, India Acko General Insurance Full time

    About UsACKO is a product-tech company, launched in 2016, solving real-world problems for customers, starting with insurance. And as a customer-first organization serving the digitally-savvy, ACKO's value proposition of 'Welcome Change' focuses on offerings that make insurance simple and hassle-free With features such as zero commission, zero paperwork,...


  • Bengaluru, India Solutions Innovantes HR Consulting Full time

    Are you a highly motivated individual with a passion for healthcare and a knack for managing teams and data analysis? We are seeking a Claims and Customer Support Manager for our client to lead our dedicated team in handling health insurance claims and improving the overall customer experience. This role combines customer support, data analysis, and...

  • Claim Processer

    3 weeks ago


    Bengaluru, Karnataka, India Acko General Insurance Full time

    **About Us** ACKO is a product-tech company, launched in 2016, solving real-world problems for customers, starting with insurance. And as a customer-first organization serving the digitally-savvy, ACKO’s value proposition of ‘Welcome Change’ focuses on offerings that make insurance simple and hassle-free! With features such as zero commission, zero...

  • Claim Processor

    3 weeks ago


    Bengaluru, Karnataka, India Acko General Insurance Full time

    **About Us** ACKO is a product-tech company, launched in 2016, solving real-world problems for customers, starting with insurance. And as a customer-first organization serving the digitally-savvy, ACKO’s value proposition of ‘Welcome Change’ focuses on offerings that make insurance simple and hassle-free! With features such as zero commission, zero...


  • Bengaluru, India Trovech Infotech Private Limited Full time

    **Responsibilities** As an insurance claims handler, you'll typically need to: - process new insurance claims notifications - provide advice on making a claim and the processes involved - collect accurate information and documents to proceed with a claim - analyse a claim made by a policymaker to establish whether it satisfies the policy conditions - guide...

  • Health Claim Process

    3 weeks ago


    Bengaluru, Karnataka, India Eteam Full time

    Role - US Health Claims Handler Role: Full timeExperience: 06months to 1yrSalary : L1: 3.3LPA, L2: 5 LPA, 1+ Yrs Location : Whitefield, Bangalore Work from Office Working Days : 5Days Job description - Document claim file by accurately capturing and updating claims data/information in compliance with best practices for low to moderate. exposure and...


  • Bengaluru, India ArowlogiQ Infotech Pvt Ltd Full time

    Shift: US shift 5 days working Location: Hobli, Bangalore Roles and Responsibilities: Summarizes documents and enters into claim system notesDocuments a claim file with notes, evaluations, and decision-making processContacts third-party carrier to review liability and subrogation response, and obtains information regarding decision to reduce amount...


  • Bengaluru, Karnataka, India MEDI ASSIST INSURANCE TPA PRIVATE LIMITED Full time

    **Job description**: **Roles and Responsibilities** 01. Involves Processing of Claims ( Preauthorization / Reimbursement claims) 02. Validating and processing these claims within TAT 03. With good communication and medical Knowledge 04. TPA Experience is an added advantage **Financial**: To see to that there is no financial implication for the...


  • Bengaluru, India Care Health Insurance (Formerly Religare Health Insurance) Full time

    Preferably looking for people with a basic medical knowledge - Preferably Pharma Graduates, MBBD, BDS, BPT,BHMS,BAMS or Nursing Investigation of claims. - Investigation of claims. - Field visits to hospitals /diagnostic centres and meeting insured. - Field visits to hospitals /diagnostic centres and meeting insured. - Submission of reports - Verification of...

  • Doctors Mbbs Freshers

    2 months ago


    Bengaluru, India Tresbien HR Staffing Full time

    Greetings! Hiring MBBS Doctors "Freshers" for processing Mediclaims\Insurance Claims for a Bangalore based Co. Industry - Healthcare Company - Pvt Ltd (PAN India) Qualification-MBBS Doctors (Freshers can apply) Experience - MBBS Freshers - Intern experience **Job Description**: - Mediclaims Processing work. Checking claims. Analysing & approving of...

  • Motor Claims-handler

    2 months ago


    Bengaluru, India Acko General Insurance Full time

    **About Us** ACKO, India’s first digital insurance company is on a mission to fundamentally redefine how the world experiences insurance. ACKO embarked on its journey to craft a versatile insurtech solution that centers around the customers needs. Today, we stand as a testament to our commitment, addressing long-standing challenges and establishing new...


  • Bengaluru, Karnataka, India Acko General Insurance Full time

    About UsACKO, India's first digital insurance company is on a mission to fundamentally redefine how the world experiences insurance.ACKO embarked on its journey to craft a versatile insurtech solution that centers around the customers needs. Today, we stand as a testament to our commitment, addressing long-standing challenges and establishing new benchmarks...


  • Bengaluru, Karnataka, India Genesis HR Services Full time

    International Voice Process Process - Insurance Claims Require experience in insurance voice process only ( no healthcare exp ) 0 to 3 years experience will work Fresher - 3 LPA For Experience - upto 5.5 LPA 5 working days, 2 days split off working location - Bangalore, Varthur 24*7 Shifts DOJ - 15th May Notice - Only those profiles who can join by...


  • Bengaluru, India SKD Health Allied Services Full time

    **Salary**: From ₹21,500.00 per month **Benefits**: - Provident Fund Schedule: - Morning shift Supplemental pay types: - Yearly bonus Ability to commute/relocate: - Bangalore, Karnataka: Reliably commute or planning to relocate before starting work (required) **Education**: - Bachelor's (required) **Experience**: - Insurance claims: 1 year...