Assistant Manager -Risk and Audit

Vidal Health Insurance; Gurugram District; On-site; INR 1,200,000 - 1,800,000; Full time

Job summary

Vidal Health Insurance is seeking an Assistant Manager for Risk and Audit to oversee risk management, audit planning, and regulatory compliance in Gurgaon. The role involves collaborating with insurers, hospitals, and operations to ensure accurate claims processing and data integrity.

You will lead audit activities, prepare MIS reports, and drive process improvements across TPA functions in a fast-paced environment.

Qualifications

• Identify, assess, and mitigate operational and compliance risks across TPA functions.
• Proficiency in internal audit planning and execution.
• Ensure adherence to IRDAI guidelines, contractual obligations, and SOPs.

Responsibilities

• Identify, assess, and mitigate operational and compliance risks across TPA functions.
• Reply on insurer's queries in paid claims and justify payments.
• Coordinate with hospitals nationwide to facilitate claims processing and audits.
• Develop and execute internal audit schedules covering claims, insurer coordination, and data processing.
• Monitor compliance with IRDAI guidelines, contracts, and SOPs.
• Suggest corrective actions to improve processes based on audit findings.
• Prepare MIS reports, risk dashboards, and audit summaries for leadership.
• Engage with insurers, medical officers, hospitals, and operations to resolve escalations.
• Supervise auditors/processors and provide training to team members.

Skills

Risk assessment

Internal audit methodologies

Compliance management

MS Excel

MIS reporting

Documentation

Education

BAMS/BDS/BUMS/BHMS/MBBS

Tools

MS Excel

Job description

Vidal is hiring for Assistant Manager role in Risk and Audit.

Location: Gurgaon,Udhyog Vihar Phase 5

Role- Assistant Manager

Key Responsibilities

• Risk management: Identify, assess, and mitigate operational and compliance risks across TPA functions.
• Reply on Insurer`s queries in paid claims .
• To prove all the payment recommended by our company justified to minimize / save recovery which has to be paid at the end by our company to insurer.
• There is also need of communication with hospitals , where there are tertiary care hospitals pan India also .
• Audit planning: Develop and execute internal audit schedules covering claims, insurer coordination, and data processing.
• Compliance monitoring: Ensure adherence to IRDAI guidelines, contractual obligations, and internal SOPs.
• Process improvement: Recommend corrective actions and streamline workflows based on audit findings.

• Reporting: Prepare detailed MIS reports, risk dashboards, and audit summaries for leadership review.

• Stakeholder engagement: Collaborate with insurers, medical officers, Hospital and operations teams to resolve escalations.

• Team leadership: Supervise auditors/processors, provide training, and ensure performance standards are met.

Required Skills

• BAMS/BDS/BUMS/BHMS/MBBS with Strong knowledge of health insurance policies, TPA processes, and regulatory frameworks.
• Expertise in risk assessment, internal audit methodologies, and compliance management.
• Proficiency in MS Excel, MIS reporting, and documentation.
• Minimum 3-6 years of experience in audit, risk, or compliance roles within the TPA/health insurance industry.

Experienced candidate should be from TPA or Health Insurance Industry