Medical Officer

Role & responsibilities

• To review Health Insurance cases referred for investigation and allocate to field investigators.
• Guide, follow-up with field investigators in closure of cases assigned as per the SLA of clients.
• Review the investigation reports submitted by the field investigators and give recommendation on authenticity of claim.
• Lead team of local internal investigators
• Maintaining data and updating in systems
• Ability to conduct digital verification, tele verifications and desktop verifications.
• Conduct data analytics and identify trends in fraud and medical abuse.
• Field investigation into high value claims and suspicious claims
• Out of box thinking skills to identify possible leads, patterns, and emerging trends in frauds/ Medical abuse.
• Healthy liaison with Insurance Companies and Brokers
• Submission of necessary reports as desired by the Client partners.
• Identify vendor partners for field verification and support capacity building
• Generate savings and support cost containment for the organisation as well as Clients.
• Must possess excellent soft skills, Problem solving ability and display a high level of integrity.
• Develop market intelligence and collaborate with industry partners for fraud risk mitigation
• The candidate must be a team player.

Preferred candidate profile

BHMS/BUMS/BAMS registration certificate is must.

Willing to work for Insurance TPA and from office.

Moulika @9177141222, moulika.r@fhpl.net