Claim Facilitator Representative

Niva Bupa

2 - 7 years

3 - 5 Lacs

ahmedabad

Posted:8 hours ago| Platform:

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Skills Required

claim investigation health claims mediclaim claims insurance claims tpa investigation field investigation fraud investigation fraud control fraud fraud detection

Work Mode

Work from Office

Job Type

Full Time

Job Description

Role & responsibilities

Responsible to Investigate Cashless/Spot and Reimbursement Claims in field.
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

Preferred candidate profile

Education

Any Graduate from any Background (Medical Background Preferred)

Experience

1-2 Years Experience in Field Investigation
Fresher can also be considered with Medical Knowledge but willing to work in field.
Knowledge of Insurance Industry
Knowledge in Computer & MS Office
Excellent Interpersonal and team working skills

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