New job Circle Head-Govt Business Health Investigations in Gujarat

Circle Head-Govt Business Health Investigations
Circle Head-Govt Business Health Investigations

Circle Head-Govt Business Health Investigations

Company : bajajallianz
Salary : Details not provided
Location : Gujarat

Full Description

  • Claim Investigation
  • Report submission and coordination with claims team. Reviewing the Investigations report which is assigned through external and internal Vendors
  • Prepare and coordinate field assignments to obtain relevant evidence and information.
  • Field Investigation for the High value cases.
  • Meeting with government agencies like, SHA, NHA, other Govt agencies in order to take the audit findings into logical conclusion.
  • Evidence assessment, discussion with the Claims Team and action on fraud identified cases.
  • Identification of Triggers conduct data analysis and explain plan of action for the field investigation.
  • Responsible to complete the case within stipulated turn-around time (TAT).
  • Conduct inquiries to ascertain the fact findings and to gather evidence in suspected fraud / triggered claims / Critical & High value claims.
  • Visiting the hospitals alone or with Medical Team to conduct audit.

  • Quality Assurance
  • Vendor Management – Training the external and internal investigators, Control measures, Quality check for the investigation reports.
  • Preparing reports based on findings and observations and guide / train the investigators to fulfil the required actions as per the scheme guidelines.
  • Training, evaluating, supporting the investigators, towards the fulfilment of the required actions
  • Ensure the ethics and compliance during managing the external and internal investigators and self-investigation of cases.
  • Document Compliance.

  • Strategic Design – Execution and Deliverables
  • Project scope assessment, identification of resources and implementation
  • Periodic analysis of fraud trend and implementation of mitigant.
  • Meeting with Government officials
  • Manage and prioritize high case load effectively and efficiently to achieve results of Timeline and Success
  • Review and research evidence/documents to analyze the overall fact pattern of claim and synthesize data into a professional report with recommendations

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