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 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: 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 Experience: 5 to 7 years Education/Qualification: Graduate/ Post Graduate Education/Qualification:Graduation/ Post Graduation Years Of Exp :4 to 8 Years
