Medezee Health Services

Position Overview We are seeking a diligent, detail-oriented, and proactive Field Investigator to join our Health Insurance Claims department. The primary role of the investigator is to verify the authenticity and validity of health insurance claims by conducting on-site investigations at hospitals, clinics, and claimant residences. This position is critical in preventing fraudulent claims and ensuring the integrity of our claims processing system. The ideal candidate will be self-motivated, possess excellent observational skills, and be comfortable with extensive local travel. Key ResponsibilitiesConduct thorough field investigations for health insurance claims as assigned by the claims team. Travel to various locations, including hospitals, nursing homes, and policyholders' residences, to gather facts and verify information. Verify the details of hospitalization, treatment provided, and medical history of the claimant. Interview claimants, family members, hospital staff, and attending doctors to corroborate claim information. Collect and examine relevant documents, such as hospital records, medical bills, discharge summaries, and diagnostic reports. Take photographs and record statements as necessary to build a comprehensive case file. Identify discrepancies, inconsistencies, or potential red flags indicative of fraudulent activity. Prepare and submit detailed, objective, and timely investigation reports using our company's mobile application and online portal. Maintain strict confidentiality and handle sensitive personal and medical information with the utmost integrity. Coordinate effectively with the in-house claims processing team to provide clear and actionable findings. Mobility: Must be willing to travel extensively within the assigned territory on a daily basis. Personal Attributes: Excellent observational and analytical skills. Strong communication and interpersonal skills to interact with diverse individuals. High level of integrity, ethics, and professionalism. Ability to work independently with minimal supervision. Good time management and organizational skills to handle multiple cases simultaneously. Preferable Qualifications Possession of a valid two-wheeler driving license. ( Optional) Ownership of a reliable bike or scooter for efficient travel. Prior experience in investigation, claims processing, or a similar field role is highly advantageous. Familiarity with basic medical terminology and hospital procedures. Good knowledge of the local geography and language(s) of the assigned area. What We Offer Competitive salary and performance-based incentives. Reimbursement for travel (fuel) and mobile expenses. Comprehensive personal accident insurance coverage. Opportunities for training and professional development. A dynamic and supportive work environment