Qureos Mentor

Daman - National Health Insurance Company

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 Core Responsibilities
 
 
 <ul>
 <li>
 Execute quality audits and control activities for claims processing.
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 Support the implementation of automated audit tools to improve efficiency and accuracy.
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 Assist in fraud detection and prevention efforts to protect financial integrity.
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 Track and report on key performance indicators (KPIs) related to claims accuracy, error rates, and audit outcomes.
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 Follow standardized review processes to ensure consistency in claims quality assessments.
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 Coordinate with the claims team to address discrepancies and support quality improvements.
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 Ensure compliance with medical coding, billing regulations, and internal policies.
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 Contribute to fostering a culture of quality assurance and continuous improvement.
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 Prepare and share audit findings and insights with senior team members to support decisions.
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 Help enhance claims quality assessment methods by applying best practices.
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 Maintain accurate documentation of audit procedures and results.
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 Support risk management by identifying potential issues in claims processing.
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 </ul>
 
 
 Quality &amp; Excellence Management
 
 
 <ul>
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 Monitor claims processing trends to help identify areas for quality improvement.
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 Assist in enhancing compliance monitoring processes.
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 Support initiatives aimed at reducing claims errors and improving efficiency.
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 Apply audit control best practices to help achieve operational excellence.
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 Provide input on technological solutions that may improve auditing processes.
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 Promote high standards in audit and control work.
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 </ul>
 
 
 Preferred Educational Qualifications and Professional Certifications
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree in Medicine (mandatory)
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 <li>
 Professional certifications such as CPCU, AICPCU, CHC, LOMA certifications, or equivalent are an advantage.
 </li>
 </ul>
 
 
 Experience
 
 
 <ul>
 <li>
 3&ndash;5 years of experience in healthcare insurance claims audit and controls.
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 Previous exposure to quality audits, compliance processes, and claims processing is preferred.
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 </ul>
 
 
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 <div id='job-id'>Job Id: 481/zIIi2n+W523uorjzVwDm3SsQI1p46owi/S130PiwZoqnxmAzWg63KuNy3L2Ld/wo0cm1KojucdzjcccBDy3ZAaf6dvRSOA==</div>

Medical Specialist, Quality Audit & Controls ( doctor)

<div>
 
 
 Job Purpose
 
 
 
 
 
 To formulate financial strategies and initiatives that enhance business performance, ensuring adherence to statutory regulations and corporate goals. Initiate financial planning and analysis processes, providing valuable insights to senior management for decision-making. Foster a data-driven approach to cost management, revenue generation, and financial efficiency.
 
 
 
 Key Responsibilities
 
 
 
 
 Core Responsibilities:
 
 
 <ul>
 <li>
 Implement financial models and forecasting techniques to support strategic decision-making.
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 Improve financial reporting processes for accurate and timely insights.
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 Establish robust budgeting mechanisms to track and control financial performance.
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 Manage cost accounting functions to ensure efficiency and profitability.
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 Initiate measures for variance analysis, identifying cost reduction opportunities.
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 Oversee financial risk assessment and mitigation planning.
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 Present financial insights to senior management, facilitating strategic planning.
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 Promote standardization of reporting structures and performance analysis.
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 Enhance business intelligence tools to improve data visualization and analytics.
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 Support capital investment evaluations, ensuring financial feasibility and impact assessment.
 
 
 </li>
 </ul>
 
 
 Quality &amp; Excellence Management:
 
 
 <ul>
 <li>
 Enhance financial reporting accuracy and adherence to compliance standards.
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 <li>
 Monitor the implementation of process improvement initiatives.
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 Establish key performance metrics to track financial efficiency.
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 Promote a culture of excellence in financial planning and analysis.
 
 
 </li>
 </ul>
 
 
 Qualifications and Experience
 
 
 
 
 Preferred Educational Qualifications and Professional Certifications
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree in Business Administration, Accounting, or Finance, or a related field.
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 <li>
 Master&rsquo;s degree in Business Administration, Accounting, or Finance, or a related field.
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 Professional certifications such as CMA (Certified Management Accountant), ACCA (Association of Chartered Certified Accountants), or equivalent are a plus.
 </li>
 </ul>
 
 
 Experience
 
 
 <ul>
 <li>
 Minimum 5-7 years of experience in financial planning &amp; analysis.
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 </ul>
 
 
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 <div id='job-id'>Job Id: kxUlVqBI5I2jBx/V7FWtBZz+IZ6myoEh50aO/qqJCQDMyBPictoCdU2wcPUkIMEMcsSfh1SUIU8iOtGT7NR5flELWgnU18MvZw==</div>

Assistant Manager, Financial Planning & Analysis

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