Cluster Manager-ILM-Health
ConfidentialLucknow, India6 days ago
Job descriptionAllocation of assigned claims to respective vendors with case relevant triggers Follow up for IR and TAT management Level 1 QC clearance & validate the submissions against shared triggers Success in claim investigation based upon strong medical & legal evidences Preparing reports based on findings and observations and guide / Gathering and Analyzing the facts and developing & creating evidence which stands in court of law Report submission and coordination with claims team. Ascertain evidence quality as per matrix Validate each & every evidence with the case triggers DMS of hardcopy maintenance Document Complaince through Field Investigation of HVC Further Requirement Complaince OFR and CFR with Stake holders MIS preparation and report reconciliation Payment reconciliation with Vendors Project tracking Vendor Empanelment & Training & Development Ensure the ethics and compliance during managing the external investigators and self- investigation of cases Vendor Payment Reconciliation Assessment of case triggers & provide to external vendors for filed investigation Validation of submitted evidences basis upon medical ethics , retrieved from the filed investigation
Desktop Investigation
- Trigger identification through data at intimation / Referral stage
- Social media searches
- Cold calling using digital platforms
- Identify key business people, link analysis
Claim Investigation
Evidence Matrix Assurance
Escalation Management
Data Management
Vendor Management
Mandatory Skills
Skills Required
Data Management, claim investigation , Vendor Management, link analysis, Payment Reconciliation, Mis Preparation
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Cluster • Lucknow, India
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