Circle Head - Health Investigation Bajaj Allianz Life insurance

Circle Head - ILM - Health Investigation

Description

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

Skills Required

Industry & Competitive Awareness ; Claims Excellence ; Impactful Communication

Education/Qualification

Graduation

Desirable Skills

1.Good communication skills. 2.Flexible & adaptable to change. 3.Well versed with MS Office. 4.Should have good analytical and problem-solving skills. 5.Should be aware of the Local language.