Cluster Manager - ILM -OD Claims Investigation Job in Kolkata at Bajaj Allianz

Bajaj Allianz is hiring for the role of Cluster Manager - ILM -OD claims Investigation!

Responsibilities of the candidate :

Desktop Investigation:

• Trigger identification through data at the 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 & validation of the submissions against shared triggers
• Success in claim investigation based upon strong medical & legal evidence
• Preparing reports based on findings and observations and guiding/Gathering and Analyzing the facts and developing & creating evidence which stands in the court of law
• Report submission and coordination with the claims team.

Evidence Matrix Assurance:

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

Escalation Management:

• Document complaints through Field Investigation of HVC
• Further Requirement Compliance
• OFR and CFR with Stakeholders

Data Management:

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

Vendor Management:

• Vendor Empanelment & Training & Development
• Ensure ethics and compliance during managing the external investigators and self-investigation of cases

Requirements:

• Assessment of case triggers & provide to external vendors for filed investigation
• Validation of submitted evidences basis upon medical ethics, retrieved from the filed
• Graduate/Post Graduate investigation