Mbbs Doctor- Risk and Audit Non Clinic

Vidal Health Insurance; Gurugram District; On-site; INR 900,000 - 1,300,000; Full time

Job summary

Vidal Health Insurance is seeking a Medical Officer in Risk and Audit to lead risk assessment, audit planning, and regulatory compliance across TPA and health insurance operations from our Gurgaon hub.

You will supervise audit activities, prepare MIS reports, and collaborate with insurers, hospitals, and operations teams to resolve escalations while driving process improvements and training for staff.

Qualifications

• MBBS/BAMS/BDS/BUMS/BHMS degree with medical background.
• Strong knowledge of health insurance policies and regulatory frameworks.
• Experience in risk assessment and internal audit methodologies.
• Proficiency in MS Excel, MIS reporting, and documentation.
• Excellent communication and stakeholder management skills.

Responsibilities

• Risk management across operational and compliance risks in TPA functions.
• Develop and execute internal audit schedules for claims, insurer coordination, and data processing.
• Ensure adherence to IRDAI guidelines, contractual obligations, and SOPs.
• Recommend corrective actions to streamline workflows based on audit findings.
• Prepare MIS reports, risk dashboards, and audit summaries for leadership.
• Collaborate with insurers, hospitals, and operations teams to resolve escalations.
• Supervise auditors/processors and provide training to maintain performance standards.

Skills

Health insurance policies

TPA processes

Regulatory frameworks

Risk assessment

Internal audit

Compliance management

MS Excel

MIS reporting

Documentation

Stakeholder management

Communication skills

Team leadership

Education

MBBS/BAMS/BDS/BUMS/BHMS

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: 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.
• 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