Team Member-od Claims Investigation - Aurangabad, Maharashtra, India - bajajallianz

bajajallianz

Verified Company

Aurangabad, Maharashtra, India

2 weeks ago

Posted by:

Deepika Kaur

beBee Recuiter

Description

Desktop Investigation

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

Mandatory Skills:

Assessment of case triggers & provide to external vendors for filed investigation - Validation of submitted evidences basis upon medical ethics, retrieved from the filed investigation

Desirable Skills:

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 Experience:

5 to 7 years

Education/Qualification:

Graduate/ Post Graduate