About the role
Primary Role Description: -
·Responsible to Investigate Cashless/Spot and Reimbursement Claims in field.
Key Roles & Responsibilities:
·Cashless & Spot cases need to be investigated within 24 hours from the allocation date.
·Reimbursement cases need to be investigated within 15 days from the allocation date.
·Pre Quality Check of Cashless and Reimbursement Claims for further investigation and Closure of his own cases.
·Need to check Previous claims documents also before doing the investigation
·Adhere to agreed TAT and accuracy
·Should highlight Central team with Fraud Proven Hospital names on basis of his findings and market feedback.
·Cases reports to be Prepared with Quality.
·Maintain Daily Sheet of all the Investigation Cases
·Coordination with within different function
·Ability to work in highly competitive & demanding environment
KEY STAKEHOLDERS
Internal:
·Customer Service and Operations Team
·Claims Team
Key Requirements – Education & Certificates
Education
·Any Graduate from any Background (Medical Background Preferred)
Key Requirements - Experience & Skills
Experience
·1-2 Years’ Experience in Field Investigation
·Fresher can also be consider with Medical Knowledge but willing to work in field.
·Knowledge of Insurance Industry
·Knowledge in Computer & MS Office
·Excellent Interpersonal and team working skills