Digital Health Claim Investigator

5 days ago


Pune, India N Shashi menon and associate Full time

**Position Overview**:As a Digital Health Claim Investigator, you will play a pivotal role in assessing and processing health insurance claims using cutting-edge digital technologies and medical expertise. Your primary responsibility will be to conduct thorough investigations to verify the legitimacy of claims, identify potential fraud, and ensure that claimants receive appropriate benefits. Your contributions will directly impact the efficiency and integrity of our claims processing system.

**Key Responsibilities**:
Review and analyze digital health insurance claims submitted by policyholders.

Utilize medical expertise and knowledge to assess the medical necessity and appropriateness of the claimed treatments, procedures, and medications.

Conduct in-depth investigations using our advanced digital tools to validate claim details and identify any discrepancies or fraudulent activities.

Collaborate with a team of professionals, including data analysts and fraud specialists, to gather evidence and develop comprehensive investigative reports.

Stay updated on the latest medical and healthcare industry trends and regulations, ensuring adherence to best practices and compliance standards.

Provide support and expertise to internal departments, such as claims processing, underwriting, and customer service, to facilitate seamless operations.

Maintain accurate and detailed records of investigations, ensuring data privacy and confidentiality are upheld at all times.

Communicate investigation findings in a clear and concise manner to management and relevant stakeholders.

**Qualifications and Requirements**:

- Medical Degree(BDS/BAMS/BHMS) and valid medical license.
- Proven experience in clinical practice, healthcare management, or medical insurance.
- Strong analytical skills and the ability to interpret complex medical information.
- Comfortable using digital tools and technologies for investigations and data analysis.
- Excellent communication and report-writing skills.
- High level of integrity, ethics, and respect for confidentiality.
- Strong attention to detail and accuracy in documenting findings.

**Why Join Us**:

- Be part of a forward-thinking organization that is revolutionizing the insurance industry with digital health solutions.
- Collaborate with a diverse and talented team dedicated to excellence and innovation.
- Opportunity for professional growth and development in a rapidly expanding field.
- Make a meaningful impact on the lives of policyholders by ensuring fair and efficient claim assessments.

**Job Types**: Full-time, Fresher

**Salary**: ₹25,000.00 - ₹30,000.00 per month

Schedule:

- Day shift

Ability to commute/relocate:

- Pune, Maharashtra: Reliably commute or planning to relocate before starting work (required)

**Experience**:

- total work: 1 year (preferred)

**Speak with the employer**
+91 7264032906



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