Position - *Claim Facilitator Representative- Senior Executive/Assistant Manager*
JOB SUMMARY:
* Responsible to Investigate Cashless/Spot and Reimbursement Claims in field.
KEY RESPONSIBILITIES:
- Cashless & Spot cases need to be investigated within 24 hours from the allocation date.
- Reimbursement cases need to be investigated within 15 days from the allocation date.
- Pre Quality Check of Cashless and Reimbursement Claims for further investigation and Closure of his own cases.
- Need to check Previous claims documents also before doing the investigation
- Adhere to agreed TAT and accuracy
- Should highlight Central team with Fraud Proven Hospital names on basis of his findings and market feedback.
- Cases reports to be Prepared with Quality.
- Maintain Daily Sheet of all the Investigation Cases
- Coordination with within different function
- Ability to work in highly competitive & demanding setting
KEY STAKEHOLDERS
Internal:
- Customer Service and Operations Team
- Claims Team
MEASURES of Success:
- Fraud Proven %
- TAT
- Quality of investigation
- Productivity
QUALIFICATION & EXPERIENCE:
- Any Graduate from any Background (Medical Background Preferred)
- 1-2 Years Experience in Field Investigation
- Knowledge of Insurance Industry
- Knowledge in Computer & MS Office
- Excellent Interpersonal and team working skills