Cluster Manager

1. Desktop Investigation

• Identify triggers at intimation/referral stage using data analytics.


• Conduct social media searches and cold calling via digital platforms.


• Perform link analysis to identify key business connections.

2. Claim Investigation

• Allocate claims to vendors based on case-specific triggers.


• Monitor Investigation Reports (IR) and manage Turnaround Time (TAT).


• Perform Level 1 QC and validate submissions against triggers.


• Ensure success in claim investigations through strong medical and legal evidence.


• Prepare detailed reports and coordinate with the claims team.

3. Evidence Matrix Assurance

• Validate evidence quality as per defined matrix.


• Maintain documentation and hardcopy records in DMS.

4. Escalation & Compliance

• Handle escalations through field investigations for high-value claims.


• Ensure compliance with OFR (Outstanding Field Requirements) and CFR (Case Finalization Requirements).

5. Data & MIS Management

• Prepare MIS reports and reconcile data.


• Track projects and reconcile vendor payments.

6. Vendor Management

• Empanel, train, and develop vendors.


• Ensure ethical practices and compliance during investigations.


• Manage vendor payment reconciliation.