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Vidal Health Insurance logo
Medical Auditor Vidal Health Insurance

0.0 - 3.0 years

3 - 5 Lacs

bengaluru

Work from Office

Role & responsibilities Perform audit reviews of adjudicated health / hospital / medical claims to verify correctness, completeness, and adherence to policy guidelines, contractual terms, and regulatory norms. Use sampling and systematic review techniques (random audits, targeted audits, high-value claims audits) to ensure quality coverage across volumes. Check for proper documentation, coding (ICD / CPT / procedure / diagnosis codes), member eligibility, policy coverage, benefit limits, copayments, exclusions, etc. Validate whether preauthorization, referrals, or supporting documentation was appropriately obtained / processed. Identify and flag discrepancies, overpayments, underpayments, du...

Posted 2 days ago

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