Job 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
- Vendor Payment Reconciliation
Education/Qualification:Gradaution
