Non-Clinical Healthcare Consulting Job at EY
Non-Clinical Healthcare Consulting Job opportunities are opening up for MBBS and MD professionals seeking roles beyond clinical practice. EY Careers has announced a position for Senior Project Consultant – Business Consulting in New Delhi, focused on healthcare claims adjudication, medical audits, and quality improvement initiatives. This Job in Delhi offers exposure to government healthcare programs and healthcare policy implementation within the Government & Public Sector (GPS) practice.
About the Company:
EY (Ernst & Young) is one of the world’s leading professional services firms, providing assurance, consulting, tax, strategy, and transaction services to clients across the globe. Operating in more than 150 countries, EY helps governments, businesses, and organizations solve complex challenges through innovation, digital transformation, and strategic consulting. Its Government & Public Sector (GPS) practice works closely with public sector organizations to improve healthcare, governance, and public services. EY is recognized for its commitment to professional development, inclusive work culture, and career growth opportunities.
Job Details:
| Company | EY (Ernst & Young) |
| Job Title | Senior Project Consultant – Business Consulting (Claims Adjudication & Audit) |
| Department | Government & Public Sector (GPS) – Business Consulting |
| Location | New Delhi, India |
| Employment Type | Full-Time |
| Experience Required | Minimum 3 years and less than 6 years of post-qualification experience |
| Reference Number | Requisition ID: 1727054 |
Healthcare Consulting Job Description:
This role involves reviewing and auditing healthcare claims processed under government health schemes. The selected candidate will assess medical necessity, appropriateness, admissibility, and compliance with scheme guidelines. Responsibilities include conducting medical and technical audits, reviewing clinical documentation, identifying discrepancies in adjudication decisions, and recommending corrective actions. The position also requires preparing audit reports, supporting implementation agencies, delivering technical training, and contributing to quality assurance frameworks. Professionals interested in a Non-Clinical Healthcare Consulting Job with exposure to public health insurance programs will engage closely with stakeholders and multidisciplinary teams.
Key Responsibilities:
- Review healthcare claims processed by Claims Processing Doctors and adjudicators.
- Assess medical necessity, admissibility, and appropriateness as per scheme guidelines.
- Conduct medical and technical audits, including random and death audits in this Non-Clinical Healthcare Consulting Job in Delhi.
- Identify discrepancies, incorrect adjudication decisions, and SOP deviations.
- Prepare detailed audit findings, observations, and follow-up reports.
- Deliver technical training and develop training materials and SOPs.
- Monitor adjudication quality and recommend workflow improvements at EY Careers.
- Identify suspicious claims and coordinate with fraud-control and analytics teams.
Educational Requirements for the Healthcare Consulting Job:
- Essential Qualification: MBBS degree from a recognized university or institution.
- Desirable Qualification: MD or an equivalent postgraduate medical qualification.
- Relevant post-qualification experience in healthcare or medical insurance-related domains.
Skills Required:
- Strong understanding of healthcare claims adjudication and medical audit.
- Knowledge of health insurance processes and claims management.
- Ability to interpret clinical records and assess medical necessity.
- Understanding of treatment guidelines and benefit packages.
- Knowledge of quality assurance and audit methodologies.
- Familiarity with fraud detection and risk identification.
- Strong analytical, report writing, and presentation skills.
- Effective communication and stakeholder management skills.
