Investigation mangement  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 solid 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  Escalation Management  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  Handling physical verification, field visits to hospitals, pharmacies, diagnostic centers etc, collect evidences and report for further action to Insurers, Corporates etc.  Analyze data on utilization, outcomes and costs to determine trends and identify problem areas.  Present findings to the management, which may include reviews, proposed solutions, and implementation of long- and short-term solutions for improvements in claim processing and cost savings.  Desktop Investigation Trigger identification through data at intimation/Referral stage  Social media searches  Cold calling using digital platforms Identify key business people, link analysi

📌 Deputy Manager (Ahmedabad)
🏢 HDFC ERGO General Insurance
📍 Ahmedabad