Claim Facilitator Representative

Job Location: - Western Line in Mumbai

Primary Role Description: -

Responsible to Investigate Cashless/Spot and Reimbursement Claims in field.

Key Roles & Responsibilities:

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• Cashless & Spot cases need to be investigated within 24 hours from the allocation date.
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• Reimbursement cases need to be investigated within 15 days from the allocation date.
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• Pre Quality Check of Cashless and Reimbursement Claims for further investigation and Closure of his own cases.
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• Need to check Previous claims documents also before doing the investigation
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• Adhere to agreed TAT and accuracy
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• Should highlight Central team with Fraud Proven Hospital names on basis of his findings and market feedback.
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• Cases reports to be Prepared with Quality.
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• Maintain Daily Sheet of all the Investigation Cases
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• Coordination with within different function
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• Ability to work in highly competitive & demanding environment
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KEY STAKEHOLDERS

Internal:

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• Customer Service and Operations Team
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• Claims Team
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Education

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• Any Graduate from any Background (Medical Background Preferred)
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Experience

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• 1-2 Years’ Experience in Field Investigation
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• Fresher can also be consider with Medical Knowledge but willing to work in field.
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• Knowledge of Insurance Industry
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• Knowledge in Computer & MS Office
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• Excellent Interpersonal and team working skill
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