Doctor

We are looking for a Hospital Audit & Recovery Officer responsible for identifying fraudulent or inflated insurance claims submitted by hospitals and initiating recovery actions based on documented evidence. The role involves audit verification, evidence presentation, coordination with hospitals, and recovery follow-ups.

• Key Responsibilities Conduct hospital audits for insurance claims flagged as suspicious or fraudulent
• Review and analyze medical records, billing documents, treatment sheets, and investigation reports
• Identify overbilling, non-admissible charges, forged documents, and policy violations
• Prepare audit findings and recovery justification reports with clear evidence
• Communicate audit observations to hospitals in a professional and compliant manner
• Handle recovery discussions and negotiations with hospital authorities
• Follow up on pending recovery amounts and ensure closure within timelines
• Coordinate with insurance companies, TPAs, and internal investigation teams
• Maintain proper documentation, evidence records, and recovery status tracking
• Ensure compliance with insurance guidelines, IRDA norms, and company SOPs
• Required Skills & Competencies Strong understanding of hospital billing and insurance claims process
• Knowledge of fraud indicators in health insurance claims
• Excellent documentation, reporting, and evidence presentation skills
• Good communication and negotiation abilities
• Ability to handle conflict situations professionally
• Attention to detail and analytical mindset
• Basic knowledge of medical terminology is preferred