Ensure claims are processed within defined turnaround time (TAT), productivity, and quality benchmarks, balancing speed with accuracy and service excellence.
Identify, investigate, and escalate potential fraud, abuse, or leakage risks, working closely with the Fraud Investigation Unit and relevant stakeholders to support effective risk mitigation.
Manage claims requiring additional information by preparing clear, professional, and compliant correspondence to claimants, healthcare providers, and third parties, ensuring timely follow‑ups and resolution.
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Leverage available automation and AI-enabled tools to enhance assessment efficiency, consistency, and accuracy
Liaise with Medical Advisors to obtain clinical guidance and clarification where required, ensuring informed and well supported claim decisions.
Perform effective suspense management, follow up on outstanding requirements, and liaise with Finance and relevant stakeholders to ensure timely and accurate claim payments.
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Review claims documentation, policy coverage, medical evidence, and loss details to determine claim validity, liability, and entitlement in accordance with Company guidelines and delegated authority.
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Leverage available automation and AI-enabled tools to enhance assessment efficiency, consistency, and accuracy
Liaise with Medical Advisors to obtain clinical guidance and clarification where required, ensuring informed and well supported claim decisions.
Perform effective suspense management, follow up on outstanding requirements, and liaise with Finance and relevant stakeholders to ensure timely and accurate claim payments.
...
Ensure claims are processed within defined turnaround time (TAT), productivity, and quality benchmarks, balancing speed with accuracy and service excellence.
Identify, investigate, and escalate potential fraud, abuse, or leakage risks, working closely with the Fraud Investigation Unit and relevant stakeholders to support effective risk mitigation.
Manage claims requiring additional information by preparing clear, professional, and compliant correspondence to claimants, healthcare providers, and third parties, ensuring timely follow‑ups and resolution.
...