Manager - Outsourced claims - Medi-Expert

2 weeks ago


India Bajaj General Insurance Full time

Job Description - Creating Panel of Doctors Medi Experts - Analyzing nationwide requirements of medical experts, identifying locations, MACTs - Identifying MBBS/BHMS doctors for interviews with Panel & processing for finalizing. - Participate in selection process to identify right candidate as medi expert - Ensuring medical experts are getting continuous support and guidance. - Assignment of cases for Review, Evidence, Verification etc.: - Identifying claims and appointing medical experts for evidence, court visit for document verification etc. - Review of MIS, data, claims diary for identifying claims with exaggerated disability, fake & fraud bills - Support & guidance to Medi experts in preparing for the Chief examination affidavit, preparing with case for evidence - Review the claim diary on daily basis to evaluate, identify, and review matters coming for BAGIC evidence in injury claims; Identifying maximum cases wherein medical experts can be utilized for leading evidence. - Provide Technical Assistance as and when required to medi experts & team members - Monitoring & Reviewing overall claims till closures and evaluating outcome. - Coordination with Stakeholders - Support & guidance to medical experts for co-ordination with panel advocate, Execution & Approval team members. - Coordinate with Advocates as and when required for claim inputs, judgments, support required etc. - Provide input to team to address issues and remove roadblocks. - Evaluation & Development: - Identify nonperforming/underperforming Medi experts; arrange for training through L&D Team; suggesting for de-panel if performance is not improved after efforts; - Identify and create development opportunities for Medi experts to enhance knowledge, Technical skills etc; - Assessment of output: - Assess the output of cases wherein Medi Experts have given evidence. - Record cost vs. savings done by Medi Experts on case to case basis Check on Claim Size Impact and take actions to minimize it



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