Trigger identification through data at intimation/Referral stage Social media searches Cold calling using digital platforms Identify key business people, link analysis
Claim Investigation
Allocation of assigned claims to respective vendors with case relevant triggers Follow up for IR and TAT management Level 1 QC clearance & validate the submissions against shared triggers Success in claim investigation based upon strong medical & legal evidences Preparing reports based on findings and observations and guide / Gathering and Analyzing the facts and developing & creating evidence which stands in court of law Report submission and coordination with claims team.
Evidence Matrix Assurance
Ascertain evidence quality as per matrix Validate each & every evidence with the case triggers DMS of hardcopy maintenance
Escalation Management
Document Complaince through Field Investigation of HVC Further Requirement Complaince OFR and CFR with Stake holders
Data Management
MIS preparation and report reconciliation Payment reconciliation with Vendors Project tracking
Vendor Management
Vendor Empanelment & Training & Development Ensure the ethics and compliance during managing the external investigators and self- investigation of cases
Department :
South
Open Positions :
1
Skills Required :
Assessment of case triggers & provide to external vendors for filed investigation \xe2\x80\xa2 Validation of submitted evidences basis upon medical ethics , retrieved from the filed investigation
Location :
Bangalore
Education/Qualification :
Graduate/ Post Graduate
Desirable Skills :
1.Good communication skills. 2.Flexible & adaptable to change. 3.Well versed with MS Office. 4.Should have good analytical and problem-solving skills. 5.Should be aware of the Local language.
Years Of Exp :
2 to 5 Years
Posted On :
31-Oct-2023
Designation :
Cluster Manager TP Claims Investigation
Beware of fraud agents! do not pay money to get a job
MNCJobsIndia.com will not be responsible for any payment made to a third-party. All Terms of Use are applicable.