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minni chopra User

@minnichoprauser

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Experienced medical claims and audit professional in health insurance.

India

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What I'm looking for

I seek a role where I can apply clinical expertise to reduce incorrect payments, lead audits and mentoring, and work within a quality-driven insurance team that values process improvement and employee development.

I am an experienced medical professional specializing in health insurance claims, clinical investigation, and internal audit, with a BHMS degree and over a decade of practice across TPAs, insurers, and clinical settings.

Currently I work as an Assistant Manager in the internal audit team at a general insurance company, where I audit claim adjudication and TPA processes to identify inadmissible payments and process errors.

I have held senior medical officer, clinical investigator, claims manager, and medical officer roles—leading small teams, training new hires on CPT coding and adjudication rules, conducting audits and reconsiderations, and managing grievance cases for corporate clients.

I bring practical clinical knowledge combined with deep experience in claims guidelines and fraud prevention, and I focus on accurate adjudication, process improvement, and mentoring to reduce incorrect payments.

Experience

Work history, roles, and key accomplishments

Current

Assistant Manager, Internal Audit

Current

Iffco Tokio General Insurance

Conduct internal audits and TPA audits to identify errors in claim adjudication, reducing inadmissible or incorrect payments and improving controls over group claim settlements.

Internal Audit TPA Audit Claim Adjudication & Compliance Process Improvement Reporting

Senior Medical Officer

Health India Insurance TPA

Jan 2023 - Apr 2024 (1 year 3 months)

Processed health insurance claims and resolved medical and policy queries; supervised a team of 2 doctors and corrected processing errors to prevent wrong payments in group health policies.

Claims Processing Medical Review Team Supervision Quality Assurance Audit Support

Clinical Investigator

Optum Global Solutions (India) Pvt. Ltd.

Apr 2020 - Oct 2022 (2 years 6 months)

Investigated potentially fraudulent claims and taught/process-audit support for new hires, improving claim validation accuracy using CPT coding and CMC/AAPC guidelines.

Fraud Detection

Claims Manager

Religare Health Insurance

Feb 2019 - Mar 2020 (1 year 1 month)

Managed claims operations to prevent fraudulent or incorrect payments using medical expertise and client-specific guidelines, and handled grievance cases and claim audits to improve accuracy.

Claims Management Fraud Prevention Medical Review Grievances Client Guidelines Audit

Medical Officer

Vipul Med Corp Insurance TPA

Feb 2017 - Feb 2019 (1 year 11 months)

Processed corporate medical claims per client policies, represented claim denials to insurers, and managed major corporate client accounts to ensure timely adjudication.

Claim Adjudication Client Management Medical Review Timely Processing

Homeopathic Physician

Private Homoeopathic Clinic

Jun 2011 - Jan 2017 (5 years 7 months)

Provided homeopathic clinical care and patient management in a private clinic, delivering diagnoses and treatment plans over a multi-year practice.

Homeopathic Treatment Treatment Planning Patient Counseling

Education

Degrees, certifications, and relevant coursework

Nehru Homoeopathic Medical College and Hospital

Bachelor of Homeopathic Medicine and Surgery (BHMS), Homeopathy

Grade: 60.09%

Activities and societies: Internship at Nehru Homoeopathic Medical College from 12 April 2010 to 11 April 2011; training under Dr. Bimal Gosain (2 Jan 2012 to 4 Jan 2014).

Completed BHMS degree from Nehru Homoeopathic Medical College and Hospital, affiliated to University of Delhi, graduating in 2010 with 60.09%.