Basic Details: Fill the required information about business, unit, location, position, reports to position and date of updation of JD
Business
Financial Service - HO
Unit
Aditya Birla Health Insurance Company Ltd
Location
Thane
Poornata Position Number of the job
Reports to: Poornata Position Number
Poornata Position Title of the job (30 characters max)
AM/DM
Reports to: Poornata Position Title
Manager
Function
Services Operations
Reports to: Function
Services Operations
Department
Ops - FWA
Reports to: Department
Ops - FWA
Designation of the Employee
Manager – Ops- FWA
Designation of the Manager
Zonal / Central Manager – Ops - FWA
Date of writing/updation of JD
22nd March 2024
1) Job Purpose: Write the purpose for which the job exists (in 2-3 lines) (Max 1325 Characters)
The purpose of this role includes
1.To do investigation of the cases referred to FWA team,
do the quality check of cases referred to investigation and at additional observation point for investigation allocate case to vendor in a given TAT and take follow up with vendor to cover 3- 5 parameter along with supporting investigation documents which will help in taking final decision on claim. Payable/rejection, query).
FWA manager need to also monitor closely to vendor on quality of investigation, parameters covered during investigation, evidences collected during investigation. Adherence to investigation TAT, vendor involvement with nexus are giving wrong report. In branch level they also need to observe FLS, local hospitals, vendors, customers, sales manager, provider manager involved in any fraudulent activity and same need to be reported to zonal manager and vertical manager.
2) Dimensions: Mention quantitative or qualitative parameters that are relevant for the job and provide a better understanding of the scope and scale of the job.
Business Workforce Number
(Max 254 Characters)
On Roll – 6000+
Offroll/ Part time – 4000+
Unit Workforce Number
(Max 254 Characters)
On Roll – 6000
Offroll/ Pa