Job
Description
Job Title: MBBS Medical expert- Claim & Insurance (Claim Adjudication & Medical Auditor) Location: Delhi/NCR Key Responsibilities Review and adjudicate medical claims for accuracy, completeness, and compliance with established guidelines and protocols. Evaluate clinical documentation and medical necessity to ensure appropriate utilization and minimize fraudulent claims. Support the development and implementation of medical audit frameworks and tools. Collaborate with internal teams, insurers, and government stakeholders for scheme design and policy formulation. Analyze claim trends, identify irregularities, and propose corrective and preventive actions. Provide expert insights and recommendations on complex medical claims and health benefits adjudication. Contribute to the design and delivery of training programs related to claims processing, auditing, and compliance. Assist in drafting SOPs, process manuals, and operational guidelines for public health insurance schemes. Participate in healthcare policy evaluation, scheme monitoring, and audit assignments for state and national-level projects. Required Qualifications & Skills Essential: MBBS from a recognized university. Minimum 3 years and 7 years of post-qualification experience in the healthcare or health insurance sector. Health insurance or underwriting. Healthcare practice or claim processing/medical insurance services. Healthcare schemes or claims management/medical auditing. Strong analytical skills with an investigative approach to claim validation. Knowledge of ICD codes, medical billing, and healthcare regulations. Desirable: MD from a recognized university or institute. Proven experience in health insurance, medical underwriting, claims adjudication, or medical audit. Familiarity with government-sponsored health schemes (e.g., PM-JAY, state insurance programs). Strong analytical mindset with attention to detail and a structured investigative approach. Proficiency in using health claims management systems and audit tools. Excellent written and verbal communication skills. KPMG India has a policy of providing equal opportunity for all applicants and employees regardless of their color, caste, religion, age, sex or gender, national origin, citizenship, sexual orientation, gender identity or expression, disability, or other legally protected status. As an equal opportunity employer, KPMG is committed to fostering a culture where everyone feels welcomed and is treated fairly. If you have any reasonable accessibility or accommodation requirement that will make you more comfortable during the assessment and recruitment process, please let us know and our Talent Acquisition colleague will connect with you
