New job Circle Head-Govt Business Health Investigations in Gujarat
|Circle Head-Govt Business Health Investigations|
Circle Head-Govt Business Health Investigations
Company : bajajallianz
Salary : Details not provided
Location : Gujarat
- 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