Merchant landing, EDC Machine, Service Role-visit customer locations and resolve queries. If you have good communication skills and a passion for customer service and sales.
The Claims Investigator is responsible for thoroughly examining and resolving insurance claims to determine their validity, compliance with policy terms, and appropriate payout. This role involves gathering and analyzing information, interviewing claimants and witnesses, and collaborating with stakeholders to ensure accurate and fair claim resolution.
Should have good typing skills, communication skills, sharp thinker.
Candidate should have- Knowledge of medical terminology, diagnostic procedures, and treatments is mandatory. Medical Knowledge: Strong understanding of diseases, treatments, diagnostic tests, and their clinical relevance. Analytical and Observational Skills: Ability to observe and assess treatment plans critically. Skill in cross-verifying diagnoses against prescribed treatments and procedures. Documentation and Research: Proficiency in reviewing and interpreting medical records, prescriptions, and reports. Capability to identify discrepancies in documentation and address them effectively. Key Responsibilities Medical Document Review: Thoroughly review medical records, prescriptions, and diagnostic reports. Validate that the treatment aligns with the diagnosis and clinical standards. Additional Requirements Excellent attention to detail and ability to focus on small yet critical discrepancies. Strong written and verbal communication skills for clear reporting and collaboration. Ability to work under pressure and manage multiple cases simultaneously. Familiarity with medical ethics and patient confidentiality laws
We are looking for a Hospital Audit & Recovery Officer responsible for identifying fraudulent or inflated insurance claims submitted by hospitals and initiating recovery actions based on documented evidence. The role involves audit verification, evidence presentation, coordination with hospitals, and recovery follow-ups. Key Responsibilities Conduct hospital audits for insurance claims flagged as suspicious or fraudulent Review and analyze medical records, billing documents, treatment sheets, and investigation reports Identify overbilling, non-admissible charges, forged documents, and policy violations Prepare audit findings and recovery justification reports with clear evidence Communicate audit observations to hospitals in a professional and compliant manner Handle recovery discussions and negotiations with hospital authorities Follow up on pending recovery amounts and ensure closure within timelines Coordinate with insurance companies, TPAs, and internal investigation teams Maintain proper documentation, evidence records, and recovery status tracking Ensure compliance with insurance guidelines, IRDA norms, and company SOPs Required Skills & Competencies Strong understanding of hospital billing and insurance claims process Knowledge of fraud indicators in health insurance claims Excellent documentation, reporting, and evidence presentation skills Good communication and negotiation abilities Ability to handle conflict situations professionally Attention to detail and analytical mindset Basic knowledge of medical terminology is preferred
Conduct insurance claim verification Verify Motor TP, Own Damage (OD), and Extended Warranty claims Interact with claimants/insured persons Verify accident details, vehicle condition, and supporting documents Prepare and submit accurate investigation reports within TAT Follow insurer SOPs and compliance guidelines or just report generation(salary will be different for just report generation)
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