Insurance Claim Auditor/ahmedabad/doctors

1 month ago


Ahmedabad, India MediEnsure Pvt Ltd Full time

**Job description**

**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



  • Ahmedabad, Gujarat, India Insurance claim Intelligence Full time

    We are hiring a field officer for ahmedabad location & his job role is to visit Hospital and patient and identify the genuineness of Insurance claim. **Salary**: From ₹15,000.00 per month **Benefits**: - Paid sick time Schedule: - Fixed shift Supplemental pay types: - Yearly bonus **Experience**: - total work: 1 year...


  • Ahmedabad, India Linear IT Solution and Staffing Services Full time

    Experience in underwriter ,claims, costumer support etc. Depth knowledge of General Insurance product and policy. **Job Types**: Full-time, Regular / Permanent **Salary**: ₹15,000.00 - ₹20,000.00 per month **Benefits**: - Health insurance Schedule: - Day shift Supplemental pay types: - Performance bonus - Yearly bonus Ability to...


  • Satellite, Ahmedabad, Gujarat, India FAMILY HEALTH PLAN INSURANCE TPA LTD Full time

    **Job Summary** MEDICAL OFFICER for TPA and INSURANCE COMPNEY **Responsibilities and Duties** CASHLESS AND REIMBURSEMENT HEALTH CLAIMS PROCESSING **Required Experience, Skills and Qualifications** BAMS/BHMS/MBBS DOCTORS Pay: ₹20,000.00 - ₹25,000.00 per month **Benefits**: - Health insurance - Leave encashment - Paid sick time - Provident...


  • Satellite, Ahmedabad, Gujarat, India FAMILY HEALTH PLAN INSURANCE TPA LTD Full time

    Freshers Are Welcome - Training Will Be Provided Responsible for Document Scanning In Company's Software ( Training Will Be Provided) Generating Claim ID On The Basis Of Claim File & Documents Respond to customer requests in a timely manner by processing Claims. **Job Types**: Full-time, Permanent, Fresher **Salary**: ₹10,999.00 - ₹14,999.00 per...

  • Tpa Executive

    4 weeks ago


    Ahmedabad, India Ravistar Job Placement Consultancy Full time

    **TPA** **(Third Party Administration & Investigation)** - Willing to work with Doctor’s as well as Patient’s. - Contact to the Doctor’s and approach them to for CASHLESS Claim settlement. (Regarding for Health Insurance Policies Claim Part) - Tie - up with Doctor’s for CASHLESS Facilities. - Willing to do documentation when Doctor is ready to...

  • Insurance Executive

    1 month ago


    Ahmedabad, India Linear IT Solution and staffing solution Full time

    Motor claims Marine claims underwriter General Insurance knowledge policy making csr in insurance **Salary**: ₹20,000.00 - ₹40,000.00 per month **Benefits**: - Health insurance Schedule: - Day shift Supplemental pay types: - Performance bonus Ability to commute/relocate: - Ahmedabad, Gujarat: Reliably commute or planning to relocate before...

  • Marketing Executive

    1 month ago


    Ahmedabad, India Zydus Hospital, Ahmedabad Full time

    Meeting Specialty doctors & informing about our doctors and services. - Communicate to doctors about services rendered, specialty we cater to, activity carried out by Zydus and be one point of contact for the same - Create network of doctors and meet them on frequent basis, communicate the advancement carried out along with new specialty and new doctor...

  • Insurance Executive

    1 month ago


    Ahmedabad, India Mantras2Success consultants Full time

    Opening: 1 Nos. Job ID: 26415 Employment Type: Full Time Reference: Work Experience: 1.0 Year(s) To 2.0 Year(s) CTC Salary: 2.16 LPA TO 2.76 LPA Function: BFSI, Investments & Trading Industry: Industrial Products/Equipment/Machinery/Projects & Engg Qualification: Any - Any Graduation; Any - Any Post-Graduation **Location**: - Ahmedabad **Industry:...

  • Insurance Underwriter

    1 month ago


    Ahmedabad, India Linear IT Solution and staffing solution Full time

    Learning and understanding company insurance products. - Working on renewal of clients coordinate with customer - Accessing customer accounts and policy schedules. - Providing customers with detailed information about policies and products. - Recommending available products. - Typing up complaint reports. - Prepare quotation, Policy, Claims **REQUIREMENTS...

  • Internal Auditor

    1 month ago


    Ahmedabad, India New Way Engineering llp Full time

    Designation Internal Auditor Preferred Industry Any Manufacturing Industries - The Internal Auditor should be able to design the audit systems and business processes for effective control of business, should be able to evaluate project report for bank finance, perform Income Tax & GST assessments, maintain statutory compliances. - Attend Income tax and GST...

  • Auditor

    1 month ago


    Ahmedabad, India Royal Staffing Services Full time

    TATA PROJECT IS HIRING FOR AUDITOR LOCATION: AHEMDABAD POST: AUDITOR INDUSTRY:*OIL & GAS QUALIFICATION: BE MECHANICAL SALALY : 60-65K CTC EXPERIENCE: MINIMUM OF 10 YEARS TIME: 10 HRS REQUIIRED SKILLS " BE & 10+ YEARS OF EXPERIENCE " HAVING CORE EXPERIENCE IN FRP REPLATED PRODUCTS (FITTINGS/PIPING/EQUIPMENT) " SHALL HAVE INDEPTH KNOWLEDGE RELATED...


  • Ahmedabad, India Bajaj Allianz General Insurance Company Full time

    : **Desktop Investigation** - Trigger identification through data at intimation/Referral stage Social media searches Cold calling using digital platforms Identify key business people, link analysis - **Claim Investigation** - Allocation of assigned claims to respective vendors with case relevant triggers Follow up for IR and TAT management Level 1 QC...

  • Internal Auditor

    2 days ago


    Ahmedabad, Gujarat, India Sayagyi Group Inc. Full time

    **Designation - Internal Auditor** **Exp - min. 2yrs as internal auditor after CA completion** **Qualification **Location - Ahmedabad (Gujrat)** Requirement: - We are looking for an internal auditor must audit all financial transactions, important business processes and statutory compliances and design systems for the same. Key Skills - Design Audit...

  • Ar Executive

    4 weeks ago


    Ahmedabad, India Mangalam Information Technologies Full time

    Job Location : Ahmedabad, Gujarat **Responsibilities**: 1. Calling Insurance Company on behalf of Doctors / Physician for claim status 2. Follow-up with Insurance Company to check status of outstanding claims 3. Handle Inbound and Outbound calls from US clients, excluding sales 4. Take in-bound calls from US Patients to fix appointments 5. Handle out-bound...

  • Virtual Rcm Assistant

    4 weeks ago


    Ahmedabad, India Mangalam Information Technologies Full time

    Job Location : Ahmedabad, Gujarat **Responsibilities**: - Calling Insurance Company on behalf of Doctors / Physician for claim status - Receiving patients calls i.e. Appointment Scheduling, re-scheduling or cancellation and any other concerns. - Follow-up with Insurance Company to check status of outstanding claims - Handle Inbound and Outbound calls -...


  • Ahmedabad, Gujarat, India Indian Institute of Management Ahmedabad Full time

    **CMHS Post-Doctoral Fellow** The Centre for Management of Healthcare Services (CMHS) is one of the oldest centres at the Indian Institute of Management Ahmedabad (IIMA). The Centre was set up in June 2004 in recognition of IIMA’s contributions to the health sector in the past and the need to strengthen the management of the health sector in the...


  • Satellite, Ahmedabad, Gujarat, India FAMILY HEALTH PLAN INSURANCE TPA LTD Full time

    Freshers Are Welcome - Training Will Be Provided Responsible for Document Scanning In Company's Software ( Training Will Be Provided) Generating Claim ID On The Basis Of Claim File & Documents Respond to customer requests in a timely manner by processing Claims. **Job Types**: Full-time, Permanent, Fresher Pay: ₹10,999.00 - ₹14,999.00 per...

  • Ar Caller

    2 days ago


    Ahmedabad, India Analytix Business Solutions (India) Ltd Full time

    Job Profile: Senior AR Caller/ AR Caller Location: Ahmedabad (WFO) **Job Type**: Full Time Industry: US Healthcare Education: 12th Pass Experience: 0.6 or 1 year (Min) **Job Description**: *Calling Insurance Companies on behalf of Doctors/ Physicians for claim status *Follow up with the Insurance company to check the status of outstanding claims *Receive...

  • Internal Auditor

    1 month ago


    Ahmedabad, India New Way Solution llp Full time

    Preferred Industry Any Manufacturing Industries - The Internal Auditor should be able to design the audit systems and business processes for effective control of business, should be able to evaluate project report for bank finance, perform Income Tax & GST assessments, maintain statutory compliances. - Attend Income tax and GST assessments - Evaluate project...

  • Insurance Agent

    4 weeks ago


    Ahmedabad, India Landmark Insurance Pvt, Ltd. Full time

    **Job Role** We are looking for a Insurance Agent to generate new business by contacting potential customers. You will sell, solicit, differentiate and negotiate insurance plans that match the needs of your assigned or prospective customers’ portfolio. **Responsibilities** - Manage Data - Back Office Work - Manage Team / Leam Leading - manage Insurance...