Team Member-ILM-Health

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

• Allocation 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.

Evidence Matrix Assurance

• Ascertain evidence quality as per matrix
• Validate each & every evidence with the case triggers
• DMS of hardcopy maintenance

Escalation Management

• Document Complaince through Field Investigation of HVC
• Further Requirement Complaince
• OFR and CFR with Stake holders

Data Management

• MIS preparation and report reconciliation
• Payment reconciliation with Vendors
• Project tracking