AM-FWA (Bengaluru)

About the role

JD for FWA Manager 1) Once the claim verification request is received from company, QC manager will study the claim, make additional triggers, refines triggers, to form customize questionnaire according to trigger, to allocate the claim for field investigation. 2) To monitor activity of field officers, to guide them and to get the claim investigated according to trigger and as per protocol, to take daily and timely updates, to maintain updates in our data. 3) To verify/ analyses evidence…

What you'll do

• Guide vendor to cover minimum 3 to 5 parameter (Insured, Hospital, treating Doctor
• Perform all those activities to cut down the claim cost of the company. b
• Identify, investigate and to report nexus/ fraud claims/ fraud advisor etc if any c
• Maintain data of all investigated cases, to identify fraud/ new fraud hospitals/ fraud pathologist/ fraud pharmacy/ fraud customers which will improves overall…
• Maintain secrecy of our internal or external data. e