Health Claim Officer at Greataim Solution Private Limited

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
Vendor Payment Reconciliation