Cluster Manager-ILM- Health Investigations

Desktop Investigation
ﾷ Trigger identification through data at intimation/Referral stageﾷ Social media searchesﾷ Cold calling using digital platformsﾷ Identify key business people, link analysisClaim Investigationﾷ Allocation of assigned claims to respective vendors with case relevant triggersﾷ Follow up for IR and TAT managementﾷ Level 1 QC clearance & validate the submissions against shared triggersﾷ Success in claim investigation based upon strong medical & legal evidencesﾷ Preparing reports based on findings and observations and guide / Gathering and Analyzing the facts and developing & creating evidence which stands in court of lawﾷ Report submission and coordination with claims team.Evidence Matrix Assuranceﾷ Ascertain evidence quality as per matrixﾷ Validate each & every evidence with the case triggersﾷ DMS of hardcopy maintenanceEscalation Managementﾷ Document Complaince through Field Investigation of HVCﾷ Further Requirement Complainceﾷ OFR and CFR with Stake holdersData Managementﾷ MIS preparation and report reconciliationﾷ Payment reconciliation with Vendorsﾷ Project trackingVendor Managementﾷ Vendor Empanelment & Training & Developmentﾷ Ensure the ethics and compliance during managing the external investigators and self- investigation of casesﾷ Vendor Payment Reconciliation