Team Member-od Claims Investigation

2 weeks ago

Ahmedabad, 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 clearance & validate the submissions against shared triggers
- Success in claim investigation based upon strong medical & legal evidences
- Preparing reports based on findings and observations and guide / Gathering and Analyzing the facts and developing & creating evidence which stands in court of law
- Report submission and coordination with claims team.

**Evidence Matrix Assurance**
- Ascertain evidence quality as per matrix
- Validate each & every evidence with the case triggers
- DMS of hardcopy maintenance

**Escalation Management**
- Document Complaince through Field Investigation of HVC
- Further Requirement Complaince
- OFR and CFR with Stake holders

**Data Management**
- MIS preparation and report reconciliation
- Payment reconciliation with Vendors
- Project tracking

**Vendor Management**
- Vendor Empanelment & Training & Development
- Ensure the ethics and compliance during managing the external investigators and self
- investigation of cases

  • Mbbs Intern

    2 days ago

    Ahmedabad, India Phoenix Assurance Claims Full time

    **Vacancy Alert | Urgent Requirement** - Medical Field Auditor - Ayushman Bharat - Ma Yojana **Hiring By**: Phoenix Assurance Pvt Ltd. **Background Of The Company**: we are the most preferred partner for majority of private insurance companies in majority parts of India for in the field of claim verification and investigation. **No Of Vacancies**: 16 - [...

  • Executive/Manager - Field Investigation Unit

    1 week ago

    Ahmedabad, Surat, India Tata AIA Life Insurance Full time ₹ 5,00,000 - ₹ 15,00,000 per year

    Role & responsibilitiesRole Summary:Identify Fraud Risk triggersPre-Issuance and Post Issuance InvestigationField InvestigationDC Audit/Mystery ShoppingVendor ManagementStakeholders InternalClaims, Finance, POS, underwriting team, Branch ops, RCU, IT, Customer Service, Legal & ComplianceStakeholders ExternalExternal legal consultant, legal counsel,...

  • Team Member

    6 days ago

    Ahmedabad, India The burger company Full time

    Team member responsibilities are taking care of customers, maintain outlet neat and clean, order taking, hygiene, food safety measures **Job Types**: Full-time, Regular / Permanent, Fresher **Salary**: ₹11,000.00 - ₹12,000.00 per month Schedule: - Rotational shift Ability to commute/relocate: - Ahmedabad, Gujarat: Reliably commute or planning to...

  • Mact Motor Legal Claims Experience Must General

    1 week ago

    Ahmedabad, Gujarat, India Serving Skill Full time

    1) Handling and management of litigation pertaining to Motor accident claims, Consumer litigation and other legal related issues, tribunals 2) Dealing with Courts, Advocates and Investigators for effective handling of claims 3) Appointment of advocates and Regular follow up with Advocates for opinions for compromise/contest 4) Adducing evidences in legal...

  • Team Member

    5 days ago

    Ahmedabad, Gujarat, India PI Health Sciences Ltd Full time ₹ 2,00,000 - ₹ 6,00,000 per year

    Job Purpose:To ensure implementation and compliance of all statutory safety requirements and internal safety systems as per applicable regulations (BOCW / Factories Act). The incumbent will support and promote a proactive safety culture, ensuring safe working conditions and practices at site.Location: Panoli, GujaratKey Responsibilities:Implement and monitor...

  • (Apply in 3 Minutes) Investigation Lead

    3 weeks ago

    Ahmedabad, India Royal Sundaram General Insurance Full time

    Job Description Key Requirement for the Position Medico with 5 yrs of work experience in similar profile 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...

  • Team Lead

    1 week ago

    Ahmedabad, Gujarat, India CrystalVoxx Global LLP Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    Company DescriptionCrystal Voxx Global LLP provides Medical Billing Services to a wide range of healthcare professionals including hospitals . We are committed to delivering high-quality services that ensure efficiency in healthcare management. Crystal Voxx Global LLP is dedicated to supporting healthcare providers in optimizing their revenue cycle...

  • Medical Officer

    2 days ago

    Ahmedabad, Gujarat, India Blaze investigation Agency Full time

    we need BAMS, BHMS, BUMS doctors for insurance regarding work. Role: - QC managers for back officer insurance claim reporting work and Medical officer for on field Health, PA/Death claims verification. **Job Types**: Full-time, Permanent Pay: ₹16,976.27 - ₹50,000.00 per month Work Location: In person

  • Team Member

    1 week ago

    Thaltej, Ahmedabad, Gujarat, India Keventers Full time

    Position - Team Member **Guest / Customer Service** Billing **Order Receiving, Product preparation, and Delivering** Material Inventory & Management **Maintain Store Hygiene** Age - 18 to 25 years **Education - Minimum 10th or 12th** **Job Types**: Full-time, Permanent, Fresher Pay: ₹10,000.00 - ₹12,000.00 per month **Benefits**: - Leave...

  • Team Member

    1 week ago

    Navrangpura, Ahmedabad, Gujarat, India Keventers Full time

    Position - Team Member - Guest / Customer Service - Billing - Order Receiving, Product preparation, and Delivering - Material Inventory & Management - Maintain Store Hygiene - Age - 18 to 25 years - Education - Minimum 10th or 12th **Job Types**: Full-time, Permanent, Fresher **Salary**: ₹10,000.00 - ₹12,000.00 per month **Benefits**: - Leave...