01Key Responsibilities
- Conduct field and desk investigations on flagged claims.
- Verify documentation, treatment history, and hospital records.
- Perform surveillance and gather evidence where required.
- Liaise with hospitals, insured members, and internal teams to gather facts.
- Collaborate with insurance companies and legal teams for case resolution.
- Prepare detailed investigation reports with findings and recommendations.
- Maintain accurate records of evidence, timelines, and communication trails.
- Identify patterns of fraud or irregularities.
- Ensure investigations comply with IRDAI guidelines and internal SOPs.
- Provide feedback to improve claim screening and fraud detection protocols.
- Support training initiatives for claims teams on red flags and triggers.
- Qualifications & Skills:
- Graduate in any discipline
- 1-3 years of experience in health insurance claims or investigation from TPA Industry
- Robust analytical and observational skills
- Excellent communication and report writing abilities
- Willingness to travel for field investigations
- Proficiency in MS Office and claims management systems
Compensation: 20,000.00 - 24,000.00 per month
Work Location: In person
Speak with the employer
+91 9311986352 .
