Job Description

• Job Summary:

We are seeking a dedicated and detail-oriented Field Investigator - Medical Officer with a BHMS degree to join our Insurance TPA team. The role involves conducting thorough investigations of medical claims to ensure accurate and fair processing. The ideal candidate will possess strong analytical skills, a keen eye for detail, and the ability to communicate effectively with various parties involved in the claims process.

Key Responsibilities:

• Claim Investigation:
• Investigate the insurance claims for genuineness, as assigned.
• Conduct field investigations for medical claims to verify the authenticity and accuracy of the information provided.
• Interview claimants, witnesses, and medical professionals to gather relevant information.
• Medical Record Review:
• Collect insured statements and records from the concerned hospitals.
• Review and analyze medical records, prescriptions, and treatment plans to ensure they meet policy guidelines and standards.
• Identify discrepancies and potential fraudulent activities in claims.
• Site Visits:
• Visit hospitals, clinics, and other healthcare facilities to verify the treatment and services provided to the claimants.
• Ensure compliance with the prescribed treatment plans and medical protocols.
• Conduct proper vicinity checks and collect evidence of fraud.
• Communication:
• Meet all involved parties in the claim to collect and verify documents.
• Liaise with healthcare providers, policyholders, and other relevant parties to obtain necessary information and clarify doubts.
• Provide clear and concise explanations of investigation findings to the claims processing team.
• Reporting:
• Prepare detailed and comprehensive investigation reports with findings and recommendations.
• Maintain accurate and organized records of all investigations conducted.
• Compliance:
• Ensure all investigations are conducted in compliance with company policies, industry regulations, and legal requirements.
• Stay updated with the latest developments in medical practices and insurance regulations.
• Training and Development:
• Participate in ongoing training programs to enhance investigation skills and medical knowledge.
• Mentor and guide junior investigators as needed.

Qualifications:

• Education: Bachelor of Homeopathic Medicine and Surgery (BHMS) degree.
• Experience: Minimum of 1-2 years of experience in a medical or healthcare setting. Prior experience in insurance investigation or claims processing is preferred.
• Skills:
• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Proficiency in reviewing and interpreting medical records.
• Ability to work independently and manage time effectively.
• Attention to detail and high level of accuracy.
• Other Requirements:
• Valid driver's license and ownership of a two-wheeler.
• Willingness to travel extensively.
• Knowledge of insurance industry standards and practices.

Job Type: Full-time

Pay: ?20,000.00 - ?35,000.00 per month

Benefits:

• Health insurance
• Paid sick time
• Paid time off
• Provident Fund

Schedule:

• Day shift

Supplemental pay types:

• Yearly bonus

Experience:

• total work: 1 year (Preferred)

Work Location: In person