Claim Facilitator Representative-Field Operations at Niva Bupa · Surat

Primary Role Description:
• Responsible to Investigate Cashless/Spot and Reimbursement Claims in field.

Key Roles & Responsibilities:
• Cashless & Spot cases need to be investigated within 24 hours from the allocation date.
• Reimbursement cases need to be investigated within 15 days from the allocation date.
• Pre Quality Check of Cashless and Reimbursement Claims for further investigation and Closure of his own cases.
• Need to check Previous claims documents also before doing the investigation
• Adhere to agreed TAT and accuracy
• Should highlight Central team with Fraud Proven Hospital names on basis of his findings and market feedback.
• Cases reports to be Prepared with Quality.
• Maintain Daily Sheet of all the Investigation Cases
• Coordination with within different function
• Ability to work in highly competitive & demanding environment

KEY STAKEHOLDERS :
• Internal: Customer Service and Operations Team

Claims Team