Key Requirement for the Position
Health & Accident Claims investigations on Reimbursement/Preauth
Quality Investigation with proper evidences, maintaining healthy success rate on Rejection/Fraud, achieving the targets assigned
Maintaining adequate TAT's
Fraud Identification with adequate use of Technology in case profiling/identification
Vendor addition, vendor training, follow up with the vendors on the assigned tasks
Filing police complaint with FIR conversion for logical conclusion
Field verification/hospital/vendors/spot
Vendor coordination, Hard copy investigation report dispatch, vendor payment/reconciliation/clearance
Ombudsman/Grievance Handling/responding to the queries of internal customers
| Job Description
Individual contributor, Handling Health & Accident Claims for Investigation and logical closures of cases. Identification of process gaps / Data analysis. Building network of vendor to support the activities. Coordination with internal customers for smooth operation of the activity. Compliance of define process. Field verification/hospital/vendors/spot. Safeguarding the interest of the Royal Sundaram GIC, Identification and Execution of projects to minimize /mitigate losses. Identification & Eradication of fraud of any form. Filing of police Complaint. Complaint conversion to FIRs. | 
