Claim Facilitator Representative

Niva Bupa Health Insurance · Mumbai, India

Job Location: - Western Line in Mumbai

Primary Role Description: -

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

Key Roles & Responsibilities:

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

KEY STAKEHOLDERS

Internal:

• Customer Service and Operations Team
• Claims Team

Education

• Any Graduate from any Background (Medical Background Preferred)

Experience

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