7 Case Review Jobs

You will be responsible for allocating portfolios to vendors based on past performance trends and Field Officers (FOS) availability, while ensuring adequate manpower capacity for the portfolio. Collaborate with FOS and Team Leaders to review cases and assign work based on disposition codes. Coordinate with agency resources for call planning to improve resolution rates and provide necessary support on challenging cases. You will oversee the allocation and periodic auditing of receipt books and Repo kits. Ensure timely closure of agency billing within 60 days of completing the work month. Obtain prior approvals for repo cases and assist agencies in managing repo-related issues. Address collection/repo customer service matters and handle escalations effectively. Collaborate with the legal team to initiate legal actions against chronic defaulters and work with enforcement agencies on cases filed against the organization by customers or third parties. Track and review BKT resolutions at the agency and FOS levels. Monitor and restrict flow rates to the next BKT based on the location you manage. Identify and replace underperforming FOS with new recruits, providing training as needed. Close CRM queries within the assigned turnaround time. Address RCU audit queries promptly and ensure the implementation of committed actions at the field level. Discuss receipt book discrepancies with agencies and prevent their recurrence in the field. Ensure 100% utilization of Hand Held Terminals (HHT) and submit reports to Area Collection Manager (ACM) or Regional Collection Manager (RCM) regularly. Report non-functioning HHTs to the IT team for necessary support.,

The ideal candidate for this position should have completed their bachelor's degree in law and possess knowledge of Accident claims and their processes. It is desirable for the candidate to have a minimum of 2 years of experience in Third Party claims. Additionally, the candidate should be proficient in speaking and writing the local language and should be familiar with the length and breadth of Karnataka. Responsibilities include taking care of settlements, defending cases in policy violation situations, traveling across Karnataka to lead evidence on behalf of the company, and ensuring timely processing of awards within the stipulated time frames of Lower courts and High Court. The candidate will be required to scrutinize investigation reports, send them to advocates with a line of action, follow up with advocates on the status of pending cases, review pending cases regularly, and maintain adequate reserves. Other miscellaneous tasks may be assigned as required from time to time. Qualifications: - LLB About Us: At Liberty General Insurance, we foster an inspired, collaborative environment where individuals can take ownership of their work, contribute breakthrough ideas, and feel confident that their efforts will be valued and their growth supported. With an employee strength of 1200 across 116 offices in 95 cities and 29 states, our partner network includes approximately 5000 hospitals and over 4000 auto service centers. Our core values - Act Responsibly, Be Open, Keep it Simple, Make things better, and Put People First - guide our everyday actions. To learn more about our unique selling propositions, please visit our website. Working with Liberty offers the opportunity to experience the One Liberty Experience, which includes providing global exposure to employees through cross-country projects, fostering Diversity, Equity & Inclusion (DEI) for equitable career opportunities, and offering flexible working arrangements. If you are looking to grow and enhance your skills in a global environment, Liberty General Insurance is the place for you! Location: Bangalore, KA, India,

As an individual responsible for portfolio management in this role, your key tasks will include allocating portfolios to vendors based on past performance trends and Field Officer availability. It will be crucial for you to create sufficient manpower capacity for the assigned portfolio. You will be expected to review cases with Field Officers and Team Leaders, assigning work based on disposition codes. Coordinating with agency resources and planning calls effectively for better case resolution will be a critical aspect of your responsibilities. Providing the necessary support to agencies on challenging cases is also part of your role. You will be accountable for the periodic allocation and auditing of receipt books and Repo kits. Ensuring timely closure of agency billing within 60 days of completing the work for the month is essential. Additionally, securing prior approvals in repo cases and assisting agencies in managing repo-related issues will be within your scope of work. Addressing collection/repo-related customer service problems and managing escalations will also be part of your responsibilities. Your role will involve collaborating with the legal team to initiate legal actions against chronic defaulters and liaising with enforcement agencies in cases filed against the organization by customers or third parties. Monitoring and reviewing BKT resolutions at the agency and Field Officer level is imperative. You will need to track and restrict flow rates to the next BKT based on the specific location you are overseeing. Identifying and removing underperforming Field Officers, recruiting new team members, and providing training as necessary are key tasks that you will be expected to undertake. Closing CRM queries within the assigned Turnaround Time (TAT) and promptly addressing RCU audit queries before the deadline will be crucial. Implementing committed actions at the field level based on audit queries is also part of your responsibilities. You will need to discuss any receipt book discrepancies with the agency to prevent their reoccurrence in the field. Ensuring 100% utilization of Hand Held Terminals (HHT) and submitting regular reports to Area Collection Managers (ACM) or Regional Collection Managers (RCM) are essential. In cases where HHTs are not functioning correctly, you are required to promptly inform the IT team for necessary support.,

You will be responsible for allocating portfolios to vendors based on past performance trends and Field Officers (FOs) availability, ensuring adequate manpower capacity for the portfolio. You will need to review cases with FOs/Team Leaders (TLs) and assign work based on the disposition code. Coordinating with agency resources, you will plan calls for better resolution and provide necessary support to the agency on challenging cases. Your duties will include allocating receipt books and Repo kits, and conducting periodic audits. It is crucial to ensure agency billing closure within 60 days of completing the work month. You will also be required to obtain prior approvals in repo cases and assist agencies in managing repo-related issues. Handling collection/repo-related customer service issues and escalations will be part of your responsibilities. You will be responsible for coordinating with the legal team to initiate legal actions against chronic defaulters and dealing with enforcement agencies in cases filed against the organization by customers/third parties. Tracking and reviewing BKT resolutions at the agency and FOs level is essential, as well as restricting flow rates to the next BKT in your location. Removing non-performing FOs, recruiting a fresh team, and providing training as needed will be part of your role. Closing CRM queries within the assigned Turnaround Time (TAT) and responding to RCU audit queries before the TAT are critical tasks. You will also need to implement committed actions at the field level based on the audit findings. Discussing receipt book discrepancies with the agency and ensuring the prevention of recurring issues in the field is important. Utilizing Hand Held Terminals (HHTs) at 100% capacity and submitting regular reports to the Area Collection Manager (ACM) or Regional Collection Manager (RCM) is required. In case of HHT malfunction, you must promptly inform the IT team for necessary support.,

You will be responsible for allocating portfolios to vendors based on past performance trends and Field Officers (FOs) availability. It will be your duty to ensure adequate manpower capacity for the portfolio. You will need to review cases with FOs / Team Leaders (TLs) and assign work based on the disposition code. Coordinating with agency resources for call planning to improve resolution rates and providing necessary support to agencies on challenging cases will also be part of your role. You will be required to allocate receipt books and Repo kits and conduct periodic audits. Ensuring closure of agency billing within 60 days of completing the work in a month is crucial. You must obtain prior approvals in repo cases and assist agencies in managing repo-related issues. Handling customer service issues and escalations related to collections/repos is another key responsibility. Coordinating with the legal team to initiate legal actions against chronic defaulters and working with enforcement agencies in cases filed against the organization by customers/third parties will be part of your duties. Tracking and reviewing BKT resolutions at agency and FOs levels is essential, along with restricting flow rates to the next BKT based on the location you handle. Identifying non-performing FOs, recruiting a new team, and providing training as necessary will be part of your responsibilities. Closing CRM queries within the assigned Turnaround Time (TAT) and addressing RCU audit queries promptly are crucial. Discussing receipt book discrepancies with agencies and ensuring issues do not recur in the field will be important. Maintaining 100% utilization of HHT and submitting regular reports to ACM / RCM is required. Informing the IT team about non-functioning HHTs for necessary support is also part of the role.,

As a Registered Nurse (RN) with active, unrestricted license in [state], your primary responsibility will be to review and assess clinical information submitted with Prior Authorization (PA) requests to determine medical necessity, appropriateness, and benefit coverage. You will conduct clinical evaluations for outpatient, inpatient, and specialty services, including J-code medications and durable medical equipment (DME) as applicable. It will be essential for you to apply CMS Medicare Advantage guidelines, internal policies, and clinical criteria (such as MCG/InterQual) to make informed decisions. Collaboration will be a key aspect of your role as you work closely with physicians, pharmacists, Utilization Management (UM) staff, and external providers to ensure accurate and timely resolution of cases. In situations involving complex or borderline cases, you will be required to escalate them to Medical Directors for a final determination. Your ability to document decisions, rationale, and communications clearly and accurately in the clinical system of record will be crucial. You will also be expected to provide support for audits, appeals, and compliance-related documentation requests, as well as participate in quality improvement initiatives and workflow optimization. Educating providers and internal teams on medical policy, coverage criteria, and regulatory requirements will be part of your regular responsibilities. To be successful in this role, you should have a minimum of 3 years of clinical experience in Utilization Management, Prior Authorization, Case Review, or related fields, along with at least 2 years of direct experience working with Medicare Advantage plans and understanding CMS requirements. Familiarity with medical management software and PA platforms, such as GuidingCare, TruCare, Epic, or similar, will be advantageous. A working knowledge of MCG/InterQual guidelines and CMS NCD/LCDs is also required. Your excellent clinical decision-making, documentation, and communication skills will be critical in this position. The ability to work independently and efficiently manage high case volumes in a fast-paced environment is essential for success. This is a full-time position with a day shift schedule. The work location is in person, and the job type is Full-time. The required experience includes 2 years of CMS Requirements and 3 years of Clinical experience.,

Roles and Responsibilities :- Allocation of portfolio to vendor basis the past performance trend and FOS availability, creating adequate manpower capacity for the portfolio. Review cases with FOS / TL and work assignment basis the disposition code. Coordinating with agency resources and doing the call planning for better resolution, ensuring appropriate support to the agency on difficult cases. Receipt book & Repo kits allocation and auditing periodically Agency billing closure within 60 days of the work completed month. Ensuring prior approvals in repo cases & helping the agency manage repo related issues. Handling collection/repo related customer service issues/escalations. Coordinating with legal team for initiating legal actions against chronic defaulters & dealing with enforcement agencies in cases filed against the organisation by customers/third parties. BKT resolution with agency and FOs level need to be tracked & reviewed. Flow rates to next BKT needs to be restricted on the location you are handling. Remove the non-performing FOs and recruitment the fresh team and train as and when required. CRM queries needs to be closed as per the TAT assigned. RCU audit queries must be reverted before TAT and implementation of committed action at field level. Receipt book discrepancies needs to be discussed with agency and ensure no reoccurrence of such issues in field. HHT 100% utilization and report to be submitted to ACM / RCM on regular basis. HHT not working need to be informed to IT team for need of support.,