Dynamic Claim Investigator and Team Lead with 5 years of experience at SKD Health Allied Services with expertise in insurance fraud and risk analysis. Proven track record in managing investigations and mentoring teams, ensuring accurate claims processing. Exceptional communication skills complement strong report generation abilities, driving efficiency and quality in service delivery.
Achievements:
Initially joined as a Field Investigation Officer and subsequently promoted to Team Lead, currently overseeing the entire team in Mangalore, Udupi, and surrounding areas.
Roles and responsibilities:-
As a Field Investigation Officer:
Conducted thorough investigations for cashless claims, reimbursement claims, personal accident cases, motor accident claims, and bill verification.
Performed on-site assessments, evidence collection, and documentation to ensure accurate claim processing.
Collaborated with stakeholders to verify claims and resolve discrepancies efficiently.
Prepared detailed reports to support claim evaluations and decision-making processes.
As a Team Lead (Mangalore, Udupi, and surrounding areas):-
Lead and manage a team responsible for handling cashless, reimbursement, personal accident, motor accident, and bill verification processes.
Oversee operations, ensuring timely and accurate completion of investigations and claims processing.
Mentor and train team members to enhance performance and maintain high standards of service delivery.
Roles and responsibilities:-
As a Quality Inspector:-
Determined quality improvement parameters by applying statistical methods relevant to manufacturing processes.
Maintained accurate documentation for auditing purposes, ensuring compliance with regulatory standards.
Prepared non-conformance reports and 8D corrective action reports to address quality issues.
Maintained calibration records and monitored operator downtime reports to optimize efficiency.
Prepared final inspection reports to ensure product quality and adherence to specifications.
Contributed to team objectives by delivering results as required.
Conducted inspections of incoming materials to verify quality standards.
Prepared rejection trend analysis charts to identify and address recurring issues.
Issued supplier Certificates of Conformance (CoC) for shipments.
Identified root causes of rejections using cause-and-effect diagrams for effective resolution.
Insurance fraud
Data review
Risk analysis
Investigation management
Investigative photography
Records management
Report generation
Claims documentation
Excellent communication
Written communication