Claims Investigation Executive

3 weeks ago


Mumbai Maharashtra, India MDIndia Healthcare Services (TPA) Pvt. Ltd. Full time

**Job description**

**Roles and Responsibilities**

1. Acts as an interface between the TPA, Insurance Company and the hospital.

2. Responsible for investigation of suspicious claims.

3. Effective usage of Fraud control measures.

4. Act as a backend support to the TPA.

5. Responsible for data mining and analytics related to Fraud and Investigation (IFD)

6. MIS reporting related to fraud control and all stakeholders.

7. Should be completely fine with doing field work (for Investigations)

8. **Should have own vehicle (2 Wheeler) with license.**
- **Qualification** Any Graduate ( Preferred - Pharmacy and Doctors)
- **Experience** Fresher / Preferably with an experience(min.1yrs) from TPA or Insurance profile.

**Job Types**: Full-time, Permanent, Fresher

**Benefits**:

- Provident Fund

Schedule:

- Day shift

Work Location: In person


  • Claims Investigator

    3 months ago


    Navi Mumbai, India Punam Investigation Agency Full time

    We are hiring for Claim investigation freelance job, any one from medical field also can apply, we need Claim Investigator who can do investigation of Mediclaim Insurance visiting hospital and patient, who have experience One of our clients requirement in Central and Harbour line of Mumbai Dombivali, Kurla, Chembur, Thane, Kalyan, Belapur, Badlapur,...

  • Claims Investigator

    3 months ago


    Akluj, Solapur, Maharashtra, India Punam Investigation Agency Full time

    We are hiring for Mediclaim Insurance Investigation Freelance job, anyone from Medical field also can apply one of our client is looking staff in Akluj **Job Type**: Freelance **Salary**: ₹9,000.00 - ₹15,000.00 per month Ability to commute/relocate: - Akluj, Solapur, Maharashtra: Reliably commute or planning to relocate before starting work...


  • Vidyavihar, Mumbai, Maharashtra, India Tresbien HR Staffing Full time

    Greetings from Tresbien HR! Hiring! Urgently required Doctors -Health Claims Investigator. TPA Co - Health Insurance. Exp - 3 Years + Location - Vidyavihar, Mumbai (1 Minute walking from station) Qualification - MBBS, BAMS, BHMS, BDS Note - "TPA Doctors only apply" Job Profile - Ø Responsibility of Pan India Investigation Operations & controlling &...

  • Medical Claims

    3 months ago


    Malad, Mumbai, Maharashtra, India Dr Claims Full time

    Verify patient insurance coverage - Generate bill estimate based on hospital guidelines and determine patient copay / deposit - Handle end to end documentation for billing and claims of health insurance patients based on information provided by the hospital - Obtain required case information and signoff from hospital and share information with insurer /...


  • 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...

  • Claims Executive

    3 months ago


    Mumbai, Maharashtra, India Croizance Business Services Full time

    Roles and Responsibilities: - 1) facilitate insurance claims. 2) Handle high-volume claim processing, including document review, data entry, and investigation. 3) Research, analyze, and resolve claims and process payments follow-ups. 4) Provide superior customer service to internal and external customers via phone, 5) Research and validate benefits,...

  • Claim Investigator

    3 months ago


    Boisar, Thane, Maharashtra, India Punam Investigation Agency Full time

    one of our client have the required in the above location **Job Type**: Part-time **Salary**: ₹9,000.00 - ₹15,000.00 per month Ability to commute/relocate: - Boisar, Thane, Maharashtra: Reliably commute or planning to relocate before starting work (required) **Experience**: - total work: 1 year (preferred) **Speak with the employer** +91...

  • Claim Executive

    2 weeks ago


    Thane R.S., Thane, Maharashtra, India JV Resume India Pvt Ltd Nagpur Full time

    M/s JV Resume India Pvt Ltd Free Placement Job Profile - Claim Executive Location - Thane Qualification - Any Graduate Experience - 2 to 5 years Salary - 35000 to 45000 Roles and Responsibilities - 1. Facilitate insurance claim 2. Handle high - volume claim processing, including, documents review, data entry and investigation 3. Research, analyze...

  • Field Investigator

    3 months ago


    Mumbai, Maharashtra, India Health India Insurance TPA Service Pvt.Ltd Full time

    _Roles & Responsibilities:_ - Checking Evidences obtained during physical investigation by investigator - Check case with policy T&C & as per investigation findings. - Prepare investigation report in detail. - Hospital experience as RMO is required. - Verify in claim treatment given to patient is Genuine \ Not. **Location**: **Work Experience**: - Medical,...

  • Claims Executive

    3 months ago


    Mumbai, Maharashtra, India Tresbien HR Staffing Full time

    Greetings! Urgently required Claims Executive for a Insurance Co. Location - Vidyavihar-Mumbai Exp - 1 Year Qualification - Any Graduate ( TPA experience Only apply) Job Profile - Should have knowledge of Cashless claims processing, required TPA Experience only Adjudication of claims on technical basis. - Computing of non-admissible items as per policy...

  • Field Investigator

    3 months ago


    Mumbai, India Health India Insurance TPA Service Pvt.Ltd Full time

    _Roles & Responsibilities:_ - Checking Evidences obtained during physical investigation by investigator - Check case with policy T&C & as per investigation findings. - Prepare investigation report in detail. - Hospital experience as RMO is required. - Verify in claim treatment given to patient is Genuine \ Not. **Location**: Hyderabad, Bihar(Patna), Delhi...

  • Claim Executive

    3 months ago


    Powai, Mumbai, Maharashtra, India N-tek consulting Pvt Ltd Full time

    The Claim Executive is responsible for working with insurers to get our customers' claims paid in a timely and satisfactory manner. This role involves coordinating with both customers and insurers, as well as reviewing and evaluating claims to ensure their validity. The Claim Executive will work closely with the rest of the claims team to provide exceptional...


  • Mumbai, Maharashtra, India LEADS 2 BUSINESS SOLUTIONS P LTD Full time

    **Urgent Opening for Team Leader - Blended Process ** Location: Malad & Thane **Salary: Up-to 6.5 LPA** Experience Required: Minimum 3 Years in same domain & 1 Year Team Handling Experince **Claims Team Leader** **Role Description**: **- **Seeking a dynamic and experienced individual to lead our Claims and Insurance Process team. **Core Role...


  • Mumbai, Maharashtra, India LEADS 2 BUSINESS SOLUTIONS P LTD Full time

    **Urgent Opening for Team Leader - Blended Process ** Location: Malad & Thane **Salary: Up-to 6.5 LPA** Experience Required: Minimum 3 Years in same domain & 1 Year Team Handling Experince **Claims Team Leader** **Role Description**: **- **Seeking a dynamic and experienced individual to lead our Claims and Insurance Process team. **Core Role...

  • Claims Administrator

    3 months ago


    Vikhroli, Mumbai, Maharashtra, India Geo Fintech Full time

    **Responsibilities**: Review and assess insurance claims to determine coverage and eligibility. Investigate claim details, including policy coverage, circumstances of loss, and supporting documentation. Communicate with policyholders, service providers, and other stakeholders to gather necessary information and documentation. Process claims accurately and...


  • Vikhroli, Mumbai, Maharashtra, India Geo Fintech Full time

    **Responsibilities**: Review and assess insurance claims to determine coverage and eligibility. Investigate claim details, including policy coverage, circumstances of loss, and supporting documentation. Communicate with policyholders, service providers, and other stakeholders to gather necessary information and documentation. Process claims accurately and...

  • Claims Administrator

    3 months ago


    Vikhroli, Mumbai, Maharashtra, India Geo Fintech Full time

    **Responsibilities**: Review and assess insurance claims to determine coverage and eligibility. Investigate claim details, including policy coverage, circumstances of loss, and supporting documentation. Communicate with policyholders, service providers, and other stakeholders to gather necessary information and documentation. Process claims accurately and...

  • Claim Executive

    3 months ago


    Mumbai, India NTEK consulting Pvt. Ltd Full time

    Job Summary: The Claim Executive is responsible for working with insurers to get our customers' claims paid in a timely and satisfactory manner. This role involves coordinating with both customers and insurers, as well as reviewing and evaluating claims to ensure their validity. The Claim Executive will work closely with the rest of the claims team to...

  • Claims Executive

    3 months ago


    Andheri, Mumbai, Maharashtra, India Europ Assistance Full time

    Position Title: Claims Executive Role Purpose: To assist the EA India Operations Team in managing claims arising from travel insurance policies sold by various insurers Key Responsibility Areas: Understand the travel insurance policy terms and conditions of various insurers Register Travel claims on system Process Travel claims as per the policy...


  • Mumbai, Maharashtra, India Robust Healthcare Solutions Full time

    **Role Description**: - Seeking a dynamic and experienced individual to lead our Claims and Insurance Process team. - Calling patient & hospital for verification **Core Role Responsibilities**: - Ensure timely and accurate processing of claims in compliance with industry standards and company policies - Maintaining high levels of confidentiality while...