Requisition Id : 1581321

 

As a global leader in assurance, tax, transaction and advisory services, we hire and develop the most passionate people in their field to help build a better working world. This starts with a culture that believes in giving you the training, opportunities and creative freedom. At EY, we don't just focus on who you are now, but who you can become. We believe that it’s your career and ‘It’s yours to build’ which means potential here is limitless and we'll provide you with motivating and fulfilling experiences throughout your career to help you on the path to becoming your best professional self.

 

The opportunity : Consultant-National-Forensics-ASU - Forensics - Investigations & Compliance - Jaipur

 

Your key responsibilities:

Medical Document Analysis: Review medical records, treatment plans, diagnostic reports, and other relevant documents attached to health insurance claims to evaluate the medical necessity and appropriateness of services rendered.

Clinical Expertise: Possess a comprehensive knowledge of medical procedures, terminology, and best practices across various medical specialties, such as cardiology, orthopedics, neurology, etc.

Regulatory Compliance: Ensure that all claims adhere to applicable insurance policies, medical guidelines, and regulatory requirements. Identify discrepancies or violations and escalate them as necessary.

Claim Review: Conduct a thorough examination of claims, verifying the accuracy of coding, billing, and documentation to identify potential errors or discrepancies.

Medical Necessity Assessment: Determine whether the medical services provided align with established medical guidelines and standards. Assess the appropriateness of treatment plans and interventions.

Communication: Collaborate with healthcare providers, insurance agents, and claimants to gather additional information or clarification regarding claims. Provide clear and concise explanations for claim denials or adjustments.

Documentation and Reporting: Maintain detailed records of audit findings, including the reasons for approvals or denials. Generate reports summarizing audit outcomes for management and regulatory purposes.

Continuous Learning: Stay up-to-date with changes in medical practices, insurance regulations, and emerging healthcare trends to enhance auditing capabilities.

 

Technical Excellence:

10 or more years of experience in Public Health.

Love for technology and an interest in developing cutting edge products.

Built strong relationships at both central and state levels with various government officials. 

Delivered projects with team size of 10 or above.

Led, developed, and won proposals with governments, iNGOs, and Development Partners.

Qualification:

 Masters in Public Health with 10+ years of experience 

What we look for

People with the ability to work in a collaborative manner to provide services across multiple client departments while following the commercial and legal requirements. You will need a practical approach to solving issues and complex problems with the ability to deliver insightful and practical solutions. We look for people who are agile, curious, mindful and able to sustain postivie energy, while being adaptable and creative in their approach. 

 

EY is equally committed to being an inclusive employer and we strive to achieve the right balance for our people - enabling us to deliver excellent client service whilst allowing our people to build their career as well as focus on their wellbeing.

 

If you can confidently demonstrate that you meet the criteria above, please contact us as soon as possible.

Join us in building a better working world. Apply now.