Claim Investigator

Medi Assist; Bengaluru; On-site; INR 600,000 - 1,200,000; Full time

Job summary

Medi Assist in Bengaluru seeks a dedicated investigator to perform fraud analysis, review flagged claims for red flags, and conduct interviews to verify statements. The role focuses on evidence gathering from medical records, surveillance, and police reports to support investigations.

You will compile comprehensive investigative reports detailing findings, coordinate with law enforcement, and testify when required. Claims processing experience will be an added advantage.

Qualifications

• Experience in investigative or fraud analytics is preferred.
• Strong interviewing and analytical skills.
• Knowledge of medical claims processes is a plus.

Responsibilities

• Fraud Analysis: Review flagged or suspicious claims for red flags, anomalies, and inconsistencies.
• Evidence Gathering: Collect physical and digital evidence, including police reports, surveillance footage, and medical records.
• Interviews: Question claimants, witnesses, and involved third parties to verify statements.
• Reporting: Compile comprehensive investigative reports detailing findings and recommended actions.
• Legal Action: Partner with law enforcement and testify in legal proceedings for fraudulent claims.
• Claims processing Experience will be a added advantage.

Job description

Key Responsibilities

• Fraud Analysis: Review flagged or suspicious claims for red flags, anomalies, and inconsistencies.
• Evidence Gathering: Collect physical and digital evidence, including police reports, surveillance footage, and medical records.
• Interviews: Question claimants, witnesses, and involved third parties to verify statements.
• Reporting: Compile comprehensive investigative reports detailing findings and recommended actions.
• Legal Action: Partner with law enforcement and testify in legal proceedings for fraudulent claims.
• Claims processing Experience will be a added advantage.