Fraud Analyst

16 hours ago

bangalore north, India Redkenko Health Tech Full time

- Maintain or exceed established standards for customer service, and resolves complex issues with little or no supervision or direction; - Analyse data from multiple sources to identify discrepancies and what, if any, remedies can eliminate suspicion and maintain compliance; - Work with peers and Managed Services leadership to communicate fraud trends and share best practices, ideas and information; - Review queued transactions and independently determine if the reviewed transactions are fraudulent or legitimate; - Investigate anomalies in underwriting that could potentially include fraud; - Write reports and document evidence, findings, and recommendations; - Perform manual fraud review to detect fraudulent transactions; - Independently resolve problems that require in depth investigation and/or research; - Conduct follow -up research on fraudulent transactions; - Issue Show cause notice to hospital or diagnostic centre wherever required.Requirements - Previous fraud prevention, investigation or retail fraud prevention experience is a plus; - Demonstrated experience and/or strong working knowledge of Microsoft Word, Excel, and Outlook; - Strong desire to build a career in the fraud industry; - Must be able to work in shift timing including weekends, and holidays; - Excellent organizational, analytical, and critical thinking skills; - Ability to meet deadlines and prioritise deliverables; - Strong innovative problem -solving capabilities; - Must have understanding of technical and financial aspects of the health insurance industry; - Strong oral and written communication skills; - Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency; - Self -starter with the ability to work under pressure independently and as part of a team; - Ability to think strategically and act proactively to create strong trust and confidence with business units.

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