Cluster Manager - ILM - Health

Desktop Investigation

ᄋ Trigger identification through data at intimation / Referral stage

ᄋ Social media searches

ᄋ Cold calling using digital platforms

ᄋ Identify key business people, link analysis

Claim Investigation

ᄋ Allocation of assigned claims to respective vendors with case relevant triggers

ᄋ Follow up for IR and TAT management

ᄋ Level 1 QC clearance & validate the submissions against shared triggers

ᄋ Success in claim investigation based upon strong medical & legal evidences

ᄋ Preparing reports based on findings and observations and guide / Gathering and Analyzing the facts and developing & creating evidence which stands in court of law

ᄋ Report submission and coordination with claims team.

Evidence Matrix Assurance

ᄋ Ascertain evidence quality as per matrix

ᄋ Validate each & every evidence with the case triggers

ᄋ DMS of hardcopy maintenance

Escalation Management

ᄋ Document Complaince through Field Investigation of HVC

ᄋ Further Requirement Complaince

ᄋ OFR and CFR with Stake holders

Data Management

ᄋ MIS preparation and report reconciliation

ᄋ Payment reconciliation with Vendors

ᄋ Project tracking

Vendor Management

ᄋ Vendor Empanelment & Training & Development

ᄋ Ensure the ethics and compliance during managing the external investigators and self- investigation of cases

ᄋ Vendor Payment Reconciliation

Skills Required

Cold Calling, Vendor Management, link analysis, Mis Preparation