Join a global leader in professional services, dedicated to building a better working world. At EY, we foster a culture of continuous learning and development, offering extensive training, diverse opportunities, and the creative freedom to shape your career. We focus on your potential, providing motivating and fulfilling experiences to help you become your best professional self.

This role is within the National Forensics Investigations & Compliance team, focusing on safeguarding and restoring enterprise and financial reputations. We help organizations investigate facts, resolve disputes, and manage regulatory challenges. Our integrated approach enhances governance, controls, culture, and data insights to manage ethical and reputational risks, building trust in capital markets worldwide.

As a Senior Project Consultant in Forensics, you will support Fraud, Waste & Abuse (FWA) management initiatives for government-funded health insurance programs. Your responsibilities will include conducting medical audits and claim reviews, identifying fraud indicators, assessing clinical appropriateness of services, and developing fraud detection mechanisms.

You will also provide technical support for claims adjudication, assist in investigations of suspect claims, and collaborate with various stakeholders including scheme authorities and healthcare providers. Furthermore, you will deliver training to claims adjudicators, prepare analytical reports, and contribute to continuous improvement of fraud prevention and control strategies.

To excel in this role, you must possess an MBBS degree from a recognized Indian university. A postgraduate medical qualification (MD or equivalent) is considered desirable.

We are seeking candidates with 3 to 6 years of relevant experience. Preferred experience includes medical audits, claims review, utilization review, healthcare fraud management, health insurance, or working with government healthcare schemes.

The ideal candidate will demonstrate a collaborative approach, practical problem-solving skills, and the ability to deliver insightful solutions. Agility, curiosity, and a positive, adaptable attitude are key attributes for success in this dynamic environment.