Medical Claims Auditor (contract)

Job Summary:

Swiss Health Consultancy is seeking a qualified Medical Claims Auditor for ad hoc assignments. This role is ideal for an experienced professional who can be called upon to audit employee health insurance claims as and when needed. The position involves reviewing, verifying, and analyzing medical claims data to detect inconsistencies, overcharges, or non-compliant billing. The auditor will contribute to cost control, compliance, and internal health governance for our corporate clients.

Key Responsibilities:

• Conduct audits of employee medical claims submitted to third-party insurers.
• Verify accuracy, necessity, and eligibility of billed services against policy terms.
• Detect and report errors such as overbilling, fraud, duplicate submissions, and upcoding.
• Compile audit findings into professional reports with actionable recommendations.
• Engage with HR teams, insurers, and care providers to clarify or resolve issues.
• Support the consultancy in shaping internal health policies using audit insights.
• Ensure all audits align with international standards and local regulatory frameworks.

Qualifications:

• Bachelor's degree in a healthcare-related field (e.g.,Medicine, Nursing, Public Health, Health Admin).
• Professional certifications such as CPMA (Certified Professional Medical Auditor) or CHC (Certified in Healthcare Compliance) are an advantage.
• At least 2–3 years’ experience in medical billing, claims auditing, or insurance review.
• Working knowledge of ICD-10, CPT codes, and Ghana’s health insurance ecosystem.
• High ethical standards and familiarity with patient data confidentiality laws.
• Ability to work independently and meet quick turnaround times.

Preferred:

• Experience in auditing within corporate or consultancy settings.
• Familiarity with ISO 9001:2015 or similar international quality frameworks.

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