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Manager - Outsourced claims - Medi-Expert

Manager - Outsourced claims - Medi-Expert

ConfidentialIndia
6 days ago
Job description
  • Creating Panel of Doctors – Medi Experts
  • Analyzing nationwide requirements of medical experts, identifying locations, MACTs
  • Identifying MBBS / BHMS doctors for interviews with Panel & processing for finalizing.
  • Participate in selection process to identify right candidate as medi expert
  • Ensuring medical experts are getting continuous support and guidance.
  • Assignment of cases for Review, Evidence, Verification etc. :
  • Identifying claims and appointing medical experts for evidence, court visit for document verification etc.
  • Review of MIS, data, claims diary for identifying claims with exaggerated disability, fake & fraud bills
  • Support & guidance to Medi experts in preparing for the Chief examination affidavit, preparing with case for evidence
  • Review the claim diary on daily basis to evaluate, identify, and review matters coming for BAGIC evidence in injury claims; Identifying maximum cases wherein medical experts can be utilized for leading evidence.
  • Provide Technical Assistance as and when required to medi experts & team members
  • Monitoring & Reviewing overall claims till closures and evaluating outcome.
  • Coordination with Stakeholders
  • Support & guidance to medical experts for co-ordination with panel advocate, Execution & Approval team members.
  • Coordinate with Advocates as and when required for claim inputs, judgments, support required etc.
  • Provide input to team to address issues and remove roadblocks.
  • Evaluation & Development :
  • Identify nonperforming / underperforming Medi experts; arrange for training through L&D Team; suggesting for de-panel if performance is not improved after efforts;
  • Identify and create development opportunities for Medi experts to enhance knowledge, Technical skills etc;
  • Assessment of output :
  • Assess the output of cases wherein Medi Experts have given evidence.
  • Record cost vs. savings done by Medi Experts on case to case basis

    • Check on Claim Size Impact and take actions to minimize it

    Skills Required

    Technical Assistance

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