AM-FWA(Bangalore)

Aditya Birla Health Insurance Company Limited; Karnataka; Vor Ort; INR 800.000 - 1.200.000; Vollzeit

Zusammenfassung

Aditya Birla Health Insurance Company Ltd in Thane is seeking a FWA investigations professional to review claims, coordinate with field staff and vendors, and ensure rigorous quality checks on investigative reports. The role emphasizes timely closure and accurate documentation, with responsibilities spanning verification, evidence assessment, and adherence to procedures.

The ideal candidate will coordinate with the vendor network, monitor TATs, and provide updates to the central OPS team to

Qualifikationen

• Investigations of referred claims and documentation.
• Vendor coordination and monitoring for TAT.
• Quality checks on investigation reports.

Aufgaben

• Study claims referred to FWA and allocate to field investigators.
• Guide field officers and ensure timely updates.
• Verify evidence and ensure compliance with procedures.
• Coordinate closure reports and update central OPS.
• Monitor claims from allocation to closure.

Kenntnisse

Investigation

Quality control

Vendor coordination

Data analysis

Jobbeschreibung

` Annexure I : ABG Job
Description Template
` HayGroup Job Description Template 2017 Basic Details: Fill the required information about business, unit, location, position, reports to position and date of updation of JD
Business Financial Service

• HO Unit Aditya Birla Health Insurance Company Ltd Location Thane
  

Poornata Position Number of the job
Reports to: Poornata Position Number Poornata Position Title of the job (30 characters max) AM/DM
Reports to: Poornata Position Title Manager Function Services Operations Reports to: Function
Services Operations Department Ops

• FWA
  

Reports to: Department
Ops

• FWA
  

Designation of the Employee
Manager – Ops- FWA Designation of the Manager
Zonal / Central Manager – Ops

• FWA Date of writing/updation of JD 22nd March 2024
  

` Annexure I : ABG Job
Description Template
` HayGroup Job Description Template 2017 1)
Job Purpose: Write the purpose for which the job exists (in 2-3 lines)
(Max 1325 Characters) The purpose of this role includes

• To do investigation of the cases referred to FWA team, do the quality check of cases referred to investigation and at additional observation point for investigation allocate case to vendor in a given TAT and take follow up with vendor to cover 3- 5 parameter along with supporting investigation documents which will help in taking final decision on claim. Payable/rejection, query). FWA manager need to also monitor closely to vendor on quality of investigation, parameters covered during investigation, evidences collected during investigation. Adherence to investigation TAT, vendor involvement with nexus are giving wrong report. In branch level they also need to observe FLS, local hospitals, vendors, customers, sales manager, provider manager involved in any fraudulent activity and same need to be reported to zonal manager and vertical manager. 2) Dimensions: Mention quantitative or qualitative parameters that are relevant for the job and provide a better understanding of the scope and scale of the job.
  

Business Workforce Number
(Max 254 Characters)
On Roll – 6000+ Offroll/ Part time – 4000+ Unit Workforce Number (Max 254 Characters)
On Roll – 6000 Offroll/ Part time – 4000+ Function Workforce Number
(Max 254 Characters)
On Roll – 800 Offroll/ Part time

• 279 Department Workforce Number
  

(Max 254 Characters)
On roll – 29 Off roll

• 2 Other Quantitative and Important Parameters for the job: Budgets/ Volumes/No. of Products/Geography/ Markets/ Customers or any other parameter
• Job Context & Major Challenges: Write the specific aspects of the job that provide a challenge (internal and external) to the jobholder in the context of the Business/Unit/Function/Department/Section ((Max 3975 Characters) 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.
• 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.
• To verify/ analyses evidence collected by field officers, to guide them if any rework is needed. Guide vendor to cover minimum 3 to 5 parameter (Insured, Hospital, treating Doctor, Lab & Pharmacy) as per case requirement ` Annexure I : ABG Job
  

Description Template
` HayGroup Job Description Template 2017 3) Job Context & Major Challenges: Write the specific aspects of the job that provide a challenge (internal and external) to the jobholder in the context of the Business/Unit/Function/Department/Section ((Max 3975 Characters) during field investigation.

• Coordinate with vendor, to make closure report as per format, to close the FWA in portal of ABHI, to update FWA Manager / Central OPS team through mail about closure of claim.
• To monitor claims from allocation to closure and to maintain