Investigation Lead

6 days ago


Lucknow India Royal Sundaram General Insurance Full time

Job Description Key Requirement for the Position Health & Accident Claims investigations on Reimbursement/Preauth Quality Investigation with proper evidences, maintaining healthy success rate on Rejection/Fraud, achieving the targets assigned Maintaining adequate TAT's Fraud Identification with adequate use of Technology in case profiling/identification Vendor addition, vendor training, follow up with the vendors on the assigned tasks Filing police complaint with FIR conversion for logical conclusion Field verification/hospital/vendors/spot Vendor coordination, Hard copy investigation report dispatch, vendor payment/reconciliation/clearance Ombudsman/Grievance Handling/responding to the queries of internal customers Job Description Individual contributor, Handling Health & Accident Claims for Investigation and logical closures of cases. Identification of process gaps / Data analysis. Building network of vendor to support the activities. Coordination with internal customers for smooth operation of the activity. Compliance of define process. Field verification/hospital/vendors/spot. Safeguarding the interest of the Royal Sundaram GIC, Identification and Execution of projects to minimize /mitigate losses. Identification & Eradication of fraud of any form. Filing of police Complaint. Complaint conversion to FIRs.



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