Medical Officer

2 weeks ago

Hyderabad Mumbai, India Family Health Plan (FHPL) Full time ₹ 9,00,000 - ₹ 12,00,000 per year

Role & responsibilities

  • To review Health Insurance cases referred for investigation and allocate to field investigators.
  • Guide, follow-up with field investigators in closure of cases assigned as per the SLA of clients.
  • Review the investigation reports submitted by the field investigators and give recommendation on authenticity of claim.
  • Lead team of local internal investigators
  • Maintaining data and updating in systems
  • Ability to conduct digital verification, tele verifications and desktop verifications.
  • Conduct data analytics and identify trends in fraud and medical abuse.
  • Field investigation into high value claims and suspicious claims
  • Out of box thinking skills to identify possible leads, patterns, and emerging trends in frauds/ Medical abuse.
  • Healthy liaison with Insurance Companies and Brokers
  • Submission of necessary reports as desired by the Client partners.
  • Identify vendor partners for field verification and support capacity building
  • Generate savings and support cost containment for the organisation as well as Clients.
  • Must possess excellent soft skills, Problem solving ability and display a high level of integrity.
  • Develop market intelligence and collaborate with industry partners for fraud risk mitigation
  • The candidate must be a team player.

Preferred candidate profile

BHMS/BUMS/BAMS registration certificate is must.

Willing to work for long term from office.

Interested candidates can reach to Moulika @ ,

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