01Overview
Job Responsibilities Visit hospitals, clinics, pharmacies, diagnostic centres and other relevant locations for claim investigation. * Verify the patients admission, treatment, diagnosis and discharge details from hospital records. * Collect and verify all required patient documents, including medical records, bills, prescriptions, reports and other supporting documents. * Conduct detailed inquiries with hospital staff, doctors, nurses, billing department and other concerned persons. * Verify the authenticity of hospital records, admission details, treatment provided and billing information. * Conduct patient-side verification and record relevant statements/details wherever required. * Identify discrepancies, inconsistencies or suspicious information during the investigation. * Complete the assigned investigation within the given timeline. * Prepare a detailed investigation report along with all supporting documents and photographs/evidence. * Compile the complete case file in PDF format and submit/update the same on the company portal or through the designated reporting system. * Maintain confidentiality of patient and insurance-related information. * Coordinate with the back-office team for any additional information or clarification required. .
