Desktop investigation (Doctor) StarHealth Insurance

1.0 - 5.0 years

0 Lacs

chennai, tamil nadu

On-site

As a Claim Investigator at Star Health and Allied Insurance Co Ltd, your main responsibilities will include: - Conducting a thorough scrutiny of claim documents to ensure accuracy and completeness. - Matching the clinic findings mentioned in the ICPs/hospital documents with the customer during calls. - Identifying suspected cases and assigning them for investigation. - Ensuring that cases sent for investigation are closed within the defined turnaround time (TAT). - Maintaining a minimum hit rate of 30%. - Assisting desktop investigation staff in conducting claim investigations. - Actively participating in team meetings, sharing relevant information, and providing suggestions for process impr...

Posted 4 months ago

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Associate Group leader - Claims Operations MD India Health Insurance TPA Pvt Ltd

1.0 - 6.0 years

0 - 3 Lacs

Pune

Work from Office

Key Responsibilities: Handle end-to-end reimbursement and cashless claims for corporate clients' employees and dependents. Scrutinize claim documents for completeness, medical validity, and compliance with policy terms. Coordinate with empaneled hospitals, insured members, and insurance companies for claim clarification, queries, and approvals. Maintain TAT and SLA commitments for smooth and timely processing. Ensure compliance with IRDAI guidelines and internal company SOPs. Update and manage claims data in the internal system accurately. Prepare and share MIS reports with internal stakeholders and corporate clients. Manage escalated and high-value claims with detailed attention and resolut...

Posted 5 months ago

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