Team Member-ILM-Motor FFRM

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 maintenance

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

Mandatory Skills:

Industry & Competitive Awareness ; Claims Excellence ; Impactful Communication

Desirable Skills:

1. Good communication skills. 2. Flexible & adaptable to change. 3. Well versed with MS Office. 4. Should have good analytical and problem-solving skills. 5. Should be aware of the Local language.

Years Of Experience

1-3 years

Education/Qualification:

Graduate/ Post Graduate