Senior Medical Claims Consultant

Requisition Id: 1761011

As a global leader in assurance, tax, transaction and advisory services, we hire and develop the most passionate people in their field to help build a better working world. This starts with a culture that believes in giving you the training, opportunities and creative freedom. At EY, we don't just focus on who you are now, but who you can become. We believe that it’s your career and ‘It’s yours to build’ which means potential here is limitless and we'll provide you with motivating and fulfilling experiences throughout your career to help you on the path to becoming your best professional self.

The opportunity : Senior Project Consultant-GOV-Business Consulting PI-CNS - BC - Transformation Delivery - New Delhi

GOV :

Our Global Government & Public Sector (GPS) is a network of highly skilled professionals dedicated to serving our clients by bringing best-in-class international experience and insight combined with local knowledge to solve the most critical problems facing governments today. We actively focus on building solutions that help public sector entities face the challenges of the future and reinvent themselves.

Digital transformation is not just about new technologies; it involves an overhaul of organizational structures, governance, work processes, culture and mindset. It also means realizing a wider vision of relationships and business models that will redesign how public services function.

To achieve this vision, we help clients balance strategic choices to re-ignite performance. We have developed a suite of cross-service line strategic solutions that align with our client priorities.

We have a proud record of helping governments meet their challenges head-on, and we work closely with them to build a world that works better for all citizens.

CNS - BC - Transformation Delivery :

EY Consulting is building a better working world by transforming businesses through the power of people, technology and innovation. Our client-centric approach focuses on driving long-term value for our clients by solving their most strategic problems. EY Consulting is made up of three sub-service lines: Business Consulting (including Performance Improvement and Risk Consulting), Technology Consulting and People Advisory Services. 

Business Consulting works with clients to reimagine or transform their business purpose and model; create growth; manage cost and efficiency; respond to market pressures and regulation; and resolve operational challenges. The scope of this team encompasses innovation, strategy and purpose, through deep functional experience in business transformation, finance, supply chain and operations, providing support for the complex and large-scale program and portfolio management.

It has multiple fields of play such as:

Finance Consulting - helps assess and transform our clients' finance function to improve performance and effectiveness. We help organizations implement service and cost improvement initiatives, and embed a performance management process and culture that unites the business around its core objectives.

Business Transformation - a m?ultidisciplinary competency, gathering capabilities in transformation architecture, experience design, business design and transformation execution to problem-solve, design and deliver large scale, multi-year, multi-stakeholder transformation programs.

Supply Chain and Operations - we provide a unique combination of industry-specific, strategic, operational and financial insights, digital technology advances and strategic alliance partners to deliver better outcomes and also help clients effect fundamental change in their operations’ performance to support sales growth, become more cost competitive, minimize risk and ensure operational resilience.

Your key responsibilities

Technical Excellence

• Strong clinical understanding combined with hands-on expertise in healthcare claims adjudication, medical/claims audit, claim processing and healthcare insurance. Ability to review claims for medical appropriateness, identify discrepancies, conduct technical/medical audits, and provide technical guidance and training to claim adjudicators.

Skills and attributes

To qualify for the role you must have
Qualification

• MBBS
• MD Community Medicine

Experience

• 3 to <6 years | Specialist / Experienced Practitioner

What we look for

People with the ability to work in a collaborative manner to provide services across multiple client departments while following the commercial and legal requirements. You will need a practical approach to solving issues and complex problems with the ability to deliver insightful and practical solutions. We look for people who are agile, curious, mindful, and able to sustain positive energy, while being adaptable and creative in their approach.

What we offer

Fuelled by the brilliance of our people, EY has emerged as the strongest brand and the most attractive employer in our field, with market-leading growth over competitors. Our people work side-by-side with market-leading entrepreneurs, game-changers, disruptors, and visionaries. As an organization, we are investing more time, technology, and money than ever before in skills and learning for our people. At EY, you will have a personalized Career Journey and also the chance to tap into the resources of our career frameworks to better know about your roles, skills, and opportunities.

EY is equally committed to being an inclusive employer, and we strive to achieve the right balance for our people—enabling us to deliver excellent client service while allowing our people to build their careers as well as focus on their wellbeing.

If you can confidently demonstrate that you meet the criteria above, please contact us as soon as possible.

Join us in shaping the future with confidence. Apply Now