Team Member-od Claims Investigation

2 weeks ago

Aurangabad Maharashtra, India bajajallianz Full time

**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

**Mandatory Skills**:
Assessment of case triggers & provide to external vendors for filed investigation - Validation of submitted evidences basis upon medical ethics, retrieved from the filed investigation

**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**:
**5 to 7 years**

**Education/Qualification**:
Graduate/ Post Graduate

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