Circle Head - Health Investigation

Circle Head - ILM - Health Investigation Description Desktop Investigation ﾷ Trigger identification through data at intimation/Referral stage ﾷ Social media searches ﾷ Cold calling using digital platforms ﾷ Identify key business people, link analysis Claim Investigation ﾷ Allocation of assigned claims to respective vendors with case relevant triggers ﾷ Follow up for IR and TAT management ﾷ Level 1 QC clearance & validate the submissions against shared triggers ﾷ Success in claim investigation based upon strong medical & legal evidences ﾷ Preparing reports based on findings and observations and guide / Gathering and Analyzing the facts and developing & creating evidence which stands in court of law ﾷ Report submission and coordination with claims team. Evidence Matrix Assurance ﾷ Ascertain evidence quality as per matrix ﾷ Validate each & every evidence with the case triggers ﾷ DMS of hardcopy maintenance Escalation Management ﾷ Document Complaince through Field Investigation of HVC ﾷ Further Requirement Complaince ﾷ OFR and CFR with Stake holders Data Management ﾷ MIS preparation and report reconciliation ﾷ Payment reconciliation with Vendors ﾷ Project tracking Vendor Management ﾷ Vendor Empanelment & Training & Development ﾷ Ensure the ethics and compliance during managing the external investigators and self- investigation of cases ﾷ Vendor Payment Reconciliation Skills Required Industry & Competitive Awareness ; Claims Excellence ; Impactful Communication Education/Qualification Graduation 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.