Hiring Health Investigations Manager - Mumbai/Bangalore/Chennai

We are hiring Health Investigations Manager (CAT Officer).

Location: Mumbai/ Bangalore/ Chennai

Role Overview:
As a Health Investigations Manager, you will oversee and manage a daily workload of 15-20 health-related claims from initiation through to final resolution. You will be responsible for investigating the authenticity of various claims (cashless, reimbursement, death, disability, etc.) by conducting thorough fieldwork, collaborating with internal and external resources, and ensuring timely case closure within stipulated TATs.

Key Responsibilities:

• Triaging Claims: Manage and prioritize claims from a larger pool, allocating resources effectively.
• Field Investigation: Conduct ground inquiries to validate the authenticity of claims, including meeting claimants, hospitals, doctors, pathologists, and other involved parties to gather necessary documentation and statements.
• Case Management: Continuously update claim details on the system, ensuring all fieldwork is logged properly and claims are closed within TAT.
• Resource Allocation: Assign and track internal and external resources for each claim, ensuring timely progress and resolution.
• Audit and Follow-up: Perform audits on claim closures, follow up regularly with internal and external teams, and drive discussions to ensure desired outcomes.
• Field Visits: Occasionally, you will be required to travel across the state to hospitals and other locations for on-site investigations.
• Maintain Performance Metrics: Ensure that success ratios, TAT, and other regional standards are met consistently.

Qualifications:

• Educational Requirements: MBBS, BHMS, BAMS, BDS, D Pharm, B Pharm, or Physiotherapist.

Experience:

• 2-3 years of clinical exposure (hospital/TPA desk/health insurance).
• 2-3 years of field investigation experience in health and benefit claims.

Skills:

• Basic clinical and investigative skills, with an ability to think outside the box.
• Strong communication and interpersonal skills for effective field interactions.
• Ability to manage multiple claims efficiently, with a strong focus on results.

Additional Requirements:

• Willingness to travel across the state for investigations.
• Ability to work independently and maintain high standards of performance while meeting deadlines.

Regards,

Ashish Sonavane,

HR Team

ICICI Lombard GIC