Medical Consultant Job at EY, Gurgaon
EY is hiring for the position of Senior Project Consultant-Forensics in Gurgaon. This EY medical consultant job requires an MBBS from a recognized institution. The application deadline is unspecified.
Job Details
Requisition Id: 1760156
Location: Gurgaon
Your Key Responsibilities:
-
Support Fraud, Waste & Abuse (FWA) management initiatives under government-funded health insurance and healthcare schemes by leveraging clinical expertise.
-
Conduct desk-based medical audits and reviews of claims submitted under government healthcare schemes.
-
Identify indicators of fraud, waste, and abuse, including inappropriate billing and other anomalous patterns.
-
Support development, refinement, and validation of fraud detection triggers, business rules, and control mechanisms.
-
Assess the clinical appropriateness of diagnoses and procedures against established treatment protocols. In this EY medical consultant job, this includes applying clinical judgement to claims assessment.
-
Provide clinical insights and technical support to strengthen claims adjudication and fraud management processes.
-
Support investigation and resolution of potentially suspect claims.
-
Collaborate with stakeholders to support fraud control initiatives.
-
Prepare audit observations and analytical reports.
-
Contribute to continuous improvement of fraud prevention, detection, and control mechanisms.
-
Undertake other activities related to Fraud, Waste & Abuse management and medical audits as assigned.
Eligibility Criteria
Qualification:
-
Essential: MBBS from a recognized Indian university/institution (FMGs will not be considered)
-
Desirable: MD or Postgraduate Medical Qualification from a recognized university/institution.
Experience:
-
3 to 6 years of experience.
-
Experience in medical audits, claims review, healthcare fraud management preferred.
Required Skills for Medical Audit Work
People with the ability to work collaboratively while following commercial and legal requirements. A practical approach to solving complex problems is needed.