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The Forensic & Integrity Services team helps organizations strengthen trust by combating fraud, improving compliance, and enabling data-driven decisions. This role specifically supports initiatives for Fraud, Waste & Abuse (FWA) management within government-funded health insurance and healthcare schemes. You will leverage clinical expertise, medical audit capabilities, and data-driven approaches to enhance scheme integrity.

Your core responsibilities will involve conducting desk-based medical audits and reviews of claims submitted under government healthcare schemes. You will identify indicators of fraud, waste, and abuse, such as inappropriate billing, unnecessary procedures, documentation inconsistencies, and duplicate claims.

This role supports the development and validation of fraud detection mechanisms, assesses the clinical appropriateness of services against established protocols, and provides technical support to claims adjudication and fraud management processes. You will also collaborate with various stakeholders, deliver technical orientations, prepare audit reports, and contribute to continuous improvement of fraud control mechanisms.

To be successful in this role, you need an MBBS degree from a recognized Indian university. A desirable qualification includes an MD or any postgraduate medical qualification from a recognized institution.

We are seeking candidates with 3 to 6 years of experience. Prior experience in medical audits, claims review, utilization review, healthcare fraud management, health insurance, or government healthcare schemes is highly preferred.

We are looking for individuals with a practical, problem-solving approach, capable of delivering insightful solutions. Adaptability, curiosity, and a positive, creative mindset are essential qualities for thriving in our collaborative environment.