Mbbs Doctor

Vidal Health Insurance; Gurugram District; On-site; INR 900,000 - 1,500,000; Full time

Job summary

Vidal Health Insurance seeks a Medical Officer for Risk and Audit in Gurgaon (Udhyog Vihar Phase 5). You will manage risk, audit plans, and compliance across TPA/claims, coordinating with insurers and hospitals to ensure accurate payouts.

Ideal candidates hold MBBS/BAMS/BDS/BHMS, have strong Excel and MIS reporting skills, and can lead audit teams, communicate clearly, and deliver dashboards for leadership.

Qualifications

• Knowledge of health insurance policies and TPA processes.
• Experience in risk assessment and internal audits.
• Proficiency in MS Excel and MIS reporting.
• Strong communication and stakeholder management.

Responsibilities

• Identify, assess, and mitigate operational and compliance risks.
• Respond to insurer queries on paid claims.
• Justify payments to minimize recoveries.
• Coordinate with hospitals across India.
• Plan and execute internal audit schedules.
• Monitor adherence to IRDAI guidelines and SOPs.
• Recommend corrective actions and streamline workflows.
• Prepare MIS reports and risk dashboards.
• Engage insurers, medical officers, and hospital teams.
• Lead auditors and provide training.

Skills

Health insurance knowledge

Risk assessment

Internal audits

Communication skills

Data analysis

Stakeholder management

Education

MBBS or equivalent

BAMS/BDS/BUMS/BHMS

Tools

MS Excel

MIS reporting

Documentation tools

Job description

Location: Gurgaon,Udhyog Vihar Phase 5

Role - Medical Officer in Risk and Audit

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

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

Stakeholder engagement

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

Team leadership

• 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.
• Analytical mindset with attention to detail and problem-solving ability.
• Excellent communication and stakeholder management skills.

Experience

• Minimum 1-5 years of experience in audit, risk, or compliance roles within the TPA/health insurance industry.
• Prior experience in leading audit teams and handling insurer/TPA escalations is preferred.

Experienced candidate should be from TPA or Health Insurance Industry