Review and analyze suspicious and potentially fraudulent insurance claims. Collaborate with claims department and industry anti-fraud organizations to resolve claims. Examine photographs and statements. Interview claimants and witnesses to gather factual information. Consult police and hospital records when needed. Investigate and process health & life insurance claims for policyholders. Verify insurance claims and determine fair amount for settlement. Research claims and incident information to deliver solutions and resolve problems.
Doctor with over 10 years of experience in claim investigation and research, claims analysis, patient care, physical therapy, and insurance policy review. Excellent reputation for resolving problems, improving customer satisfaction, and driving overall operational improvements. Consistently saved costs while increasing profits. Enthusiastic and eager to contribute to team success through hard work, attention to detail, and excellent organizational skills. Motivated to learn, grow and excel in the health insurance industry.
Review and analyze suspicious and potentially fraudulent insurance claims.
Collaborate with claims department and industry anti-fraud organizations to resolve claims.
Examine photographs and statements.
Interview claimants and witnesses to gather factual information.
Consult police and hospital records when needed.
Investigate and process health & life insurance claims for policyholders.
Verify insurance claims and determine fair amount for settlement.
Research claims and incident information to deliver solutions and resolve problems.
Review and analyze suspicious and potentially fraudulent insurance claims.
Collaborate with claims department and industry anti-fraud organizations to resolve claims.
Examine photographs and statements.
Interview claimants and witnesses to gather factual information.
Consult police and hospital records when needed.
Investigate and process health & life insurance claims for policyholders.
Verify insurance claims and determine fair amount for settlement.
Research claims and incident information to deliver solutions and resolve problems.
Claims Investigation
undefinedControlled fraudulent and suspicious claims in blacklisted hospital of central UP.
Recognized the pattern of few blacklisted hospitals to produce fraudulent claims and timely intervention by regular field visits. Blacklisted one of notorious hospital of Lucknow to control fraud.
Apt in use of technology in investigation, use of goggle maps & goggle time line, Social Media and online confirmation of doctors registration.
Controlled fraud by recognizing fraudulent pathology and indoor case paper entries made by non medico background.
Information Security, Cyber Security and Business Continuity Management System
Information Security, Cyber Security and Business Continuity Management System
Prohibition of Sexual Harassment FY 20-21
Anti Money Laundering FY 20-21