Cluster Manager-Reimbursement Claims Investigations

1 week ago

Chennai India Bajaj General Insurance Full time

Job Description - Desktop Investigation - Identify triggers at intimation/referral stage using data analytics. - Conduct social media searches and cold calling via digital platforms. - Perform link analysis to identify key business connections. - Claim Investigation - Allocate claims to vendors based on case-specific triggers. - Monitor Investigation Reports (IR) and manage Turnaround Time (TAT). - Perform Level 1 QC and validate submissions against triggers. - Ensure success in claim investigations through strong medical and legal evidence. - Prepare detailed reports and coordinate with the claims team. - Evidence Matrix Assurance - Validate evidence quality as per defined matrix. - Maintain documentation and hardcopy records in DMS. - Escalation & Compliance - Handle escalations through field investigations for high-value claims. - Ensure compliance with OFR (Outstanding Field Requirements) and CFR (Case Finalization Requirements). - Data & MIS Management - Prepare MIS reports and reconcile data. - Track projects and reconcile vendor payments. - Vendor Management - Empanel, train, and develop vendors. - Ensure ethical practices and compliance during investigations. - Manage vendor payment reconciliation.

  • 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...

  • Reimbursement Analyst

    2 weeks ago

    Chennai G.P.O, Chennai, Tamil Nadu, India MEDLEARN VISION HEALTH CARE SOLUTIONS PVT LTD Full time

    A Reimbursement Analyst is a finance and healthcare professional responsible for ensuring accurate payment processing, claim analysis, and regulatory compliance in medical billing and reimbursement systems.Key ResponsibilitiesReview and analyze healthcare claims for correctness, completion, and compliance with payer rules and government regulations.Identify...

  • Reimbursement Specialist

    3 weeks ago

    Bengaluru, India Total RCM Solutions Full time

    Job Description Company Overview: Total RCM Solutions, LLC, established in June 2018, is a prominent revenue cycle management company catering to healthcare providers across the United States. With over 100 years of combined expertise, our team excels in applying tailored processes and workflows to optimize practice success. We offer comprehensive end-to-end...

  • Health Claim Specialist

    4 days ago

    Chennai, India iAssist Innovations Labs Full time

    Job Description: We are seeking a detail- oriented and experienced Health Claims Specialist to join our team. The ideal candidate will be responsible for accurately processing and adjudicating medical claims in accordance with company policies, industry regulation, and contractual agreements. The Health Claims Specialist will play a crucial role in ensuring...

  • Health Claim Specialist

    5 days ago

    Chennai, India iAssist Innovations Labs Full time

    Job Description: We are seeking a detail- oriented and experienced Health Claims Specialist to join our team. The ideal candidate will be responsible for accurately processing and adjudicating medical claims in accordance with company policies, industry regulation, and contractual agreements. The Health Claims Specialist will play a crucial role in ensuring...

  • Health Claim Specialist

    2 days ago

    India iAssist Innovations Labs Full time

    Job Description Job Description: We are seeking a detail- oriented and experienced Health Claims Specialist to join our team. The ideal candidate will be responsible for accurately processing and adjudicating medical claims in accordance with company policies, industry regulation, and contractual agreements. The Health Claims Specialist will play a crucial...

  • Cluster Manager-ILM-Motor TP

    2 weeks ago

    Ranchi, India Bajaj General Insurance Full time

    Job Description 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 -...

  • Health Claim Specialist

    4 days ago

    Chennai, India iAssist Innovations Labs Full time

    Job Description:We are seeking a detail- oriented and experienced Health Claims Specialist to join our team. The ideal candidate will be responsible for accurately processing and adjudicating medical claims in accordance with company policies, industry regulation, and contractual agreements. The Health Claims Specialist will play a crucial role in ensuring...

  • Cluster Manager-ILM-Motor TP

    12 hours ago

    Ranchi, India Bajaj Allianz General Insurance Company Limited Full time

    Job Description Job Description : 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...

  • Claim Inspector

    2 weeks ago

    India Driver Logistics Full time

    Claims inspector / scrap handlers review claims to verify both the claimant and claim adjuster followed due process during the investigation and reporting phase of a case. Claims examiners ensure compliance and approve or deny claims while assisting adjusters when needed. They diligently review reports to ensure that no errors have been made in the appraisal...