AM- FWA (Thane GCorp)

JD for FWA Manager 1) Once the claim verification request is received from company QC manager will study the claim make additional triggers refines triggers to form customize questionnaire according to trigger to allocate the claim for field investigation. 2) To monitor activity of field officers to guide them and to get the claim investigated according to trigger and as per protocol to take daily and timely updates to maintain updates in our data. 3) To verify/ analyses evidence collected by field officers to guide them if any rework is needed. Guide vendor to cover minimum 3 to 5 parameter (Insured Hospital treating Doctor Lab & Pharmacy) as per case requirement during field investigation. 4) Coordinate with vendor to make closure report as per format to close the FWA in portal of ABHI to update FWA Manager / Central OPS team through mail about closure of claim. 5) To monitor claims from allocation to closure and to maintain quality of investigation. As per given product TAT for investigation. 6) To deliver assignment in TAT to achieve companies target and to work in such a way which will not hamper parameter working from home (at night on holidays Sundays) must be done as per requirement of seniors and as per company protocol. 7) To maintain harmonious relationship with all managers in FWA Claim provider team higher management staff in branch location / clients/ Vendors/officer managers/supporting staff. 8) To maintain target of company 95% TAT and 30% Success ratio A grade quality evidence with minimal escalations to maintain hygiene in document collection. 9) Confidentiality of work Nature of work and insureds data base should be protected with utmost care. Digital work ethics like keeping camera on while attending meeting prior information about late joining distraction at background while Microsoft Teams/ Digital/Virtual meet/ training 10) To execute all strategies duties efforts which increases business of company in ethical way. a. To perform all those activities to cut down the claim cost of the company. b. To identify investigate and to report nexus/ fraud claims/ fraud advisor etc if any c. To maintain data of all investigated cases to identify fraud/ new fraud hospitals/ fraud pathologist/ fraud pharmacy/ fraud customers which will improves overall performance. d. To maintain secrecy of our internal or external data. e. No opinion/pro rejection/query cases discussion with Zonal Manager /Claim manager prior closure.

Required Experience:

Manager