Niva Bupa - Assistant Manager/Deputy Manager - Claims

Primary Role Description:

- Pre QC - Allocation

- Responsible to monitor the quality of investigations carried out by the investigation agencies & verification officers - Follow-up with the Agencies/CRFs

- To quality check the investigation reports & evidences received from field and submit with recommendation for claim processing

- Co-ordinate with field investigators and help/guide them on claim investigations

- TAT management

Key Roles & Responsibilities:

- To comply with departmental SOP with respect to: fraud investigation, reporting and recovery

- Measurement and documentation of fraud detection scorecard

- Fraud audits

- Data Management

Key Requirements - Education & Certificates:

- A master's/bachelor's degree

- Minimum 2+ years of experience in the health insurance claims/ fraud investigations or related areas

Key Requirements - Experience & Skills:

- Good working knowledge of MS Office (MS Word, MS Excel, MS PowerPoint).

- Good analytical skills

- Good organizational, planning and delivery skills

- Strong people management /interaction skills

- Fluent in Hindi and English both written and spoken

- Team handling skills/experience

- Multi-tasking and ability to work under pressure in a fast paced environment

- Adhering to Max Bupa principles and values