Medical Officer
- Family Health Plan
- 0 - 5 years
- Mumbai
- 1 day ago
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Job Description
Role & responsibilities
- To review Health Insurance cases referred for investigation and allocate to field investigators.
- Guide, follow-up with field investigators in closure of cases assigned as per the SLA of clients.
- Review the investigation reports submitted by the field investigators and give recommendation on authenticity of claim.
- Maintaining data and updating in systems
- Ability to conduct digital verification, tele verifications and desktop verifications.
- Conduct data analytics and identify trends in fraud and medical abuse.
- Field investigation into high value claims and suspicious claims
- Out of box thinking skills to identify possible leads, patterns, and emerging trends in frauds/ Medical abuse.
- Healthy liaison with Insurance Companies and Brokers
- Submission of necessary reports as desired by the Client partners.
- Identify vendor partners for field verification and support capacity building
- Generate savings and support cost containment for the organisation as well as Clients.
- Must possess excellent soft skills, Problem solving ability and display a high level of integrity.
- Develop market intelligence and collaborate with industry partners for fraud risk mitigation
Preferred candidate profile
BHMS/BAMS/BUMS candidates with relevant experience preferred.
Interested candidates can call or refer to Moulika @9177141***, mo******r@fh*l.net
Job Classification
Industry: InsuranceFunctional Area / Department: Customer Success, Service & OperationsRole Category: Customer Success, Service & Operations - OtherRole: Customer Success, Service & Operations - OtherEmployement Type: Full timeContact Details:
Company: Family Health PlanLocation(s): Mumbai
Keyskills: Claims Adjudication Health Claims Mediclaim Insurance Claims TPA Medical Insurance Claims Processing Health Insurance
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