Coe- Cashless, Hospital Audit - Pune, India - Bajaj Allianz General Insurance Company

Bajaj Allianz General Insurance Company

Verified Company

Pune, India

3 weeks ago

Posted by:

Deepika Kaur

beBee Recuiter

Description

:

Virtual Investigation
Investigation / Verification of all Cashless claims intimated to company Through Video Connect
Create the Bank of questions as per trigger for Virtual Investigations
Monitor the daily Transactional flow hospital wise to know the trends
Understand the Trend (from field / hospitals / NGOs / other medical or non-medical reports / evidences) gathered; Prepare the strategy for carrying out investigation
Identify triggers for investigation by analyzing the trends and studying the Loss ratio.

Analyse intelligence gathered along with evidence; conduct detailed study on possible occurrences and guide team in firming recommendations by collecting more inputs / evidence.

Ensuring increase in success rate and teams' productivity

Investigations

Oversee day-to-day verification of documents for health cashless settlements ,personal accident and Travel claims Investigations; review cases requiring special attention and direct team to carry out investigations.

Lead the team and provide advice & guidance on various areas related to fraud control, fraud mitigation and investigation.

Gather evidence from different sources (people in vicinity, field, etc.) in case of accidents; review post-mortem reports to ascertain genuineness of the claim and guide team to assess the reliability of the claim; provide all the information, with evidence and summary to the claims team for processing.

Make periodic field investigations for critical / high value cases.

Hospital Audit

Strategic inputs and model to develop Hospital Audit intelligence.

Examine and evaluate evidence for conflicting interpretations and resolve issues
Draft Detailed Investigation Audit report and coordinate with Networks team for actions
Identifying threats and providing recommendations on fighting crimes through Deterrence.

Team Development and Engagement

Establish individual performance expectations and regularly review the performance of the team.

Identify and create development opportunities for team members to enhance functional knowledge.

Guide team in disseminating critical information / experience within the team to ensure the organization achieves target combined ratio by containing loss due to fraudulent claims.

Deterrence
Creating impact on the field that fraudsters will be punished.
Representation to Government agencies, like Police, court, etc. as and when needed.
Identifying the nexus and taking into logical conclusion by filing police complaints

Operational Reviews

Ensuring reported data authenticity for management consumption

Periodic reviews with superior and the claims team to highlight performance & present recommendations.

Present insights to supervisors on Fraud trends / Triggers and Measures to mitigate frauds.

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Department
:

HO

Open Positions
:

1

Skills Required:

:

Critical thinking, Analytical mindset

Role
:

3

Location
:

Head Office - Pune

Education/Qualification
:

Graduate

Years Of Exp
:

10 to 15 Years

Posted On
: