Claim & Quality Auditor

18 hours ago

Indore, Madhya Pradesh, India Widevista Pvt ltd Full time ₹ 3,00,000 - ₹ 4,00,000 per year

Job Summary:

We are seeking a detail-oriented and experienced Claim & Quality Auditor to ensure accuracy, compliance, and efficiency across the claims process. The ideal candidate will be responsible for reviewing claim files, identifying process gaps, ensuring adherence to company and regulatory standards, and recommending corrective actions to improve overall claim quality and operational performance.

Key Responsibilities:

  • Conduct regular audits of insurance claims (health, life, motor, or general) to ensure compliance with internal policies and regulatory guidelines.
  • Review claim documentation, approvals, and settlements for accuracy, completeness, and consistency.
  • Identify discrepancies, errors, or potential fraud and provide detailed audit findings to relevant stakeholders.
  • Develop and implement quality assurance metrics and audit checklists.
  • Collaborate with claims, underwriting, and operations teams to ensure continuous process improvement.
  • Provide training and feedback to claim processors and assessors on audit findings and best practices.
  • Prepare detailed audit reports and summaries for management review.
  • Track audit results, monitor corrective actions, and ensure timely closure of non-compliance issues.
  • Support compliance and risk management initiatives by maintaining updated knowledge of IRDAI and other regulatory requirements.

Requirements:

  • Bachelor's degree in Insurance, Commerce, Finance, or a related field (Master's preferred).
  • 1–3 years of experience in claims auditing, quality assurance, or insurance operations.
  • Strong understanding of insurance claim processes, documentation, and regulatory requirements.
  • Excellent analytical, investigative, and problem-solving skills.
  • High attention to detail and accuracy.
  • Proficient in MS Excel, audit tools, and claims management systems.
  • Strong communication and report-writing skills.

Job Type: Full-time

Pay: ₹15, ₹30,000.00 per month

Work Location: In person

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