Cluster Manager - ILM - Health

3 - 8 years

8 - 9 Lacs

Posted:6 days ago| Platform: Naukri logo

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Work Mode

Work from Office

Job Type

Full Time

Job Description

Desktop Investigation

Trigger identification through data at intimation/Referral stage

Social media searches

Cold calling using digital platforms

Identify key business people, link analysis

Claim Investigation

Allocation of assigned claims to respective vendors with case relevant triggers

Follow up for IR and TAT management

Level 1 QC clearance & validate the submissions against shared triggers

Success in claim investigation based upon strong medical & legal evidences

Preparing reports based on findings and observations and guide / Gathering and Analyzing the facts and developing & creating evidence which stands in court of law

Report submission and coordination with claims team.

Evidence Matrix Assurance

Ascertain evidence quality as per matrix

Validate each & every evidence with the case triggers

DMS of hardcopy maintece

Escalation Management

Document Complaince through Field Investigation of HVC

Further Requirement Complaince

OFR and CFR with Stake holders

Data Management

MIS preparation and report reconciliation

Payment reconciliation with Vendors

Project tracking

Vendor Management

Vendor Empanelment & Training & Development

Ensure the ethics and compliance during managing the external investigators and self- investigation of cases

Vendor Payment Reconciliation

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