Senior Executive - Claims Facilitator Representative
Niva Bupa · India; India
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Collected role description
<table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0"> <tbody><tr table_type="formatted" style="border-left: 1px solid black !important;mso-yfti-irow:0;mso-yfti-firstrow:yes;mso-yfti-lastrow:yes; height:16.6pt"> <td width="623" style="width:467.5pt;border:solid windowtext 1.0pt;padding: 0cm 5.4pt 0cm 5.4pt;height:16.6pt"> <p class="MsoNormal"><b><span lang="EN-US" style="font-size:10.0pt;color:black;mso-ansi-language:EN-US">Primary Role Description: -<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-left:18.0pt;text-indent:-18.0pt;mso-list: l1 level1 lfo1"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt; font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol; color:black;mso-ansi-language:EN-US;mso-bidi-font-weight:bold">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; font-family:'Trebuchet MS','sans-serif';color:black;mso-ansi-language:EN-US">Responsible to Investigate Cashless/Spot and Reimbursement Claims in field.</span><b><span lang="EN-US" style="font-size:10.0pt;color:black;mso-ansi-language:EN-US"><o:p></o:p></span></b></p> </td> </tr> </tbody></table> <p class="MsoNormal"><b><span lang="EN-US" style="font-size:10.0pt;color:black; mso-ansi-language:EN-US"> </span></b></p> <p class="MsoNormal"><b><span style="font-size:10.0pt;color:black"> </span></b></p> <table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0"> <tbody><tr table_type="formatted" style="border-left: 1px solid black !important;mso-yfti-irow:0;mso-yfti-firstrow:yes;height:17.5pt"> <td width="623" style="width:467.5pt;border:solid windowtext 1.0pt;padding: 0cm 5.4pt 0cm 5.4pt;height:17.5pt"> <p class="MsoNormal"><b><span lang="EN-US" style="font-size:10.0pt;color:black;mso-ansi-language:EN-US">Key Roles & Responsibilities:<o:p></o:p></span></b></p> </td> </tr> <tr table_type="formatted" style="border-left: 1px solid black !important;mso-yfti-irow:1;height:50.35pt"> <td width="623" valign="top" style="width: 467.5pt; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-left: 1pt solid windowtext; border-image: initial; border-top-width: initial; border-top-color: initial; padding: 0cm 5.4pt; height: 50.35pt;"> <p class="MsoListParagraphCxSpFirst" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; color:black;mso-ansi-language:EN-US">Cashless & Spot cases need to be investigated within 24 hours from the allocation date.<o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; color:black;mso-ansi-language:EN-US">Reimbursement cases need to be investigated within 15 days from the allocation date.<o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; color:black;mso-ansi-language:EN-US">Pre Quality Check of Cashless and Reimbursement Claims for further investigation and Closure of his own cases.<o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; color:black;mso-ansi-language:EN-US">Need to check Previous claims documents also before doing the investigation<o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; color:black;mso-ansi-language:EN-US">Adhere to agreed TAT and accuracy <o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; color:black;mso-ansi-language:EN-US">Should highlight Central team with Fraud Proven Hospital names on basis of his findings and market feedback. <o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; color:black;mso-ansi-language:EN-US">Cases reports to be Prepared with Quality. <o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; color:black;mso-ansi-language:EN-US">Maintain Daily Sheet of all the Investigation Cases <o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; color:black;mso-ansi-language:EN-US">Coordination with within different function <o:p></o:p></span></p> <p class="MsoListParagraphCxSpLast" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; color:black;mso-ansi-language:EN-US">Ability to work in highly competitive & demanding environment<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left:18.0pt"><span lang="EN-US" style="font-size:10.0pt;font-family:'Trebuchet MS','sans-serif';color:black; mso-ansi-language:EN-US"> </span></p> <p class="MsoNormal" style="text-align:justify;line-height:12.0pt;text-autospace: none"><b><u><span lang="EN-US" style="font-size:10.0pt;font-family:'Trebuchet MS','sans-serif'; color:black;mso-ansi-language:EN-US">KEY STAKEHOLDERS<o:p></o:p></span></u></b></p> <p class="Default" style="text-align:justify"><b><span lang="EN-US" style="font-size:10.0pt;font-family:'Trebuchet MS','sans-serif';mso-ansi-language: EN-US">Internal:</span></b><span lang="EN-US" style="font-size:10.0pt; font-family:'Trebuchet MS','sans-serif';mso-ansi-language:EN-US"> <o:p></o:p></span></p> <p class="Default" style="margin-left:15.3pt;text-align:justify;text-indent: -14.2pt;mso-list:l4 level1 lfo3"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; font-family:'Trebuchet MS','sans-serif';mso-ansi-language:EN-US">Customer Service and Operations Team<o:p></o:p></span></p> <p class="Default" style="margin-left:15.3pt;text-align:justify;text-indent: -14.2pt;mso-list:l4 level1 lfo3"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; font-family:'Trebuchet MS','sans-serif';mso-ansi-language:EN-US">Claims Team<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-US" style="font-size:10.0pt;font-family:'Trebuchet MS','sans-serif'; color:black;mso-ansi-language:EN-US"> </span></p> </td> </tr> <tr table_type="formatted" style="border-left: 1px solid black !important;mso-yfti-irow:2;height:17.5pt"> <td width="623" style="width: 467.5pt; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-left: 1pt solid windowtext; border-image: initial; border-top-width: initial; border-top-color: initial; background: rgb(0, 176, 240); padding: 0cm 5.4pt; height: 17.5pt;"> <p class="MsoListParagraph" align="center" style="margin-left:0cm;mso-add-space: auto;text-align:center;text-indent:-.9pt"><b><span lang="EN-US" style="font-size:10.0pt;font-family:'Calibri','sans-serif';color:white; mso-ansi-language:EN-US">Key Requirements – Education & Certificates</span></b><b><span lang="EN-US" style="font-size:10.0pt;font-family:'Calibri','sans-serif'; color:black;mso-ansi-language:EN-US"><o:p></o:p></span></b></p> </td> </tr> <tr table_type="formatted" style="border-left: 1px solid black !important;mso-yfti-irow:3;height:26.05pt"> <td width="623" style="width: 467.5pt; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-left: 1pt solid windowtext; border-image: initial; border-top-width: initial; border-top-color: initial; padding: 0cm 5.4pt; height: 26.05pt;"> <p class="Default" style="text-align:justify"><b><span lang="EN-US" style="font-size:10.0pt;mso-ansi-language:EN-US">Education </span></b><span lang="EN-US" style="font-size:10.0pt;mso-ansi-language:EN-US"><o:p></o:p></span></p> <p class="MsoListParagraph" style="text-indent:-18.0pt;mso-list:l2 level1 lfo4"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; font-family:'Calibri','sans-serif';color:black;mso-ansi-language:EN-US">Any Graduate from any Background (Medical Background Preferred)<o:p></o:p></span></p> </td> </tr> <tr table_type="formatted" style="border-left: 1px solid black !important;mso-yfti-irow:4;height:18.4pt"> <td width="623" style="width: 467.5pt; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-left: 1pt solid windowtext; border-image: initial; border-top-width: initial; border-top-color: initial; background: rgb(0, 176, 240); padding: 0cm 5.4pt; height: 18.4pt;"> <p class="MsoListParagraph" align="center" style="margin-left:0cm;mso-add-space: auto;text-align:center;text-indent:-.9pt"><b><span lang="EN-US" style="font-size:10.0pt;font-family:'Calibri','sans-serif';color:white; mso-ansi-language:EN-US">Key Requirements - Experience & Skills</span></b><b><span lang="EN-US" style="font-size:10.0pt;font-family:'Calibri','sans-serif'; color:black;mso-ansi-language:EN-US"><o:p></o:p></span></b></p> </td> </tr> <tr table_type="formatted" style="border-left: 1px solid black !important;mso-yfti-irow:5;mso-yfti-lastrow:yes;height:24.25pt"> <td width="623" style="width: 467.5pt; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-left: 1pt solid windowtext; border-image: initial; border-top-width: initial; border-top-color: initial; padding: 0cm 5.4pt; height: 24.25pt;"> <p class="Default" style="text-align:justify"><b><span lang="EN-US" style="font-size:10.0pt;mso-ansi-language:EN-US">Experience </span></b><span lang="EN-US" style="font-size:10.0pt;mso-ansi-language:EN-US"><o:p></o:p></span></p> <p class="MsoListParagraphCxSpFirst" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; font-family:'Calibri','sans-serif';mso-ansi-language:EN-US">1-2 Years’ Experience in Field Investigation <o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; font-family:'Calibri','sans-serif';mso-ansi-language:EN-US">Fresher can also be consider with Medical Knowledge but willing to work in field. <o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; font-family:'Calibri','sans-serif';mso-ansi-language:EN-US">Knowledge of Insurance Industry<o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; font-family:'Calibri','sans-serif';mso-ansi-language:EN-US">Knowledge in Computer & MS Office<o:p></o:p></span></p> <p class="MsoListParagraphCxSpLast" align="left" style="text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:10.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;mso-ansi-language:EN-US">·<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="EN-US" style="font-size:10.0pt; font-family:'Calibri','sans-serif';mso-ansi-language:EN-US">Excellent Interpersonal and team working skills<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="EN-US" style="font-size:10.0pt;mso-ansi-language:EN-US"> </span></p> </td> </tr> </tbody></table> <p class="MsoNormal"><o:p> </o:p></p>
Collected experience requirement
2 - 6 Years