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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 sustain updates in our data. 3) To verify/ evaluates 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) Collaborate with vendor, to make closure report as per format, to close the FWA in portal of ABHI, to update FWA Manager / Central OPS group through mail about closure of claim. 5) To monitor claims from allocation to closure and to sustain quality of investigation. As per given product TAT for investigation. 6) To deliver assignment in TAT, to reach 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 sustain harmonious relationship with all managers in FWA, Claim, provider group, higher management staff in branch location, / clients/ Vendors/officer managers/assisting staff. 8) To sustain target of company, 95% TAT and 30% Success ratio, A grade quality evidence with minimal escalations, to sustain hygiene in document collection. 9) Confidentiality of work, Nature of work and insured's 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 execute 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 sustain data of all investigated cases, to identify fraud/ new fraud hospitals/ fraud pathologist/ fraud pharmacy/ fraud clients which will improves overall performance. d. To sustain secrecy of our internal or external data. e. No opinion/pro rejection/query cases discussion with Zonal Manager /Claim manager prior closure.
This opening is for the AM-FWA(Jaipur) position in ABHI Jaipur.
Eligibility typically includes the qualifications and experience outlined in the job description above, with around 1-5 Years years of relevant experience expected for this role.
The key responsibilities for this role are detailed in the Key Responsibilities section above, covering the core duties expected of a AM-FWA(Jaipur) at Aditya Birla Group.
This role requires around 1-5 Years years of relevant experience, as specified in the job listing. Please refer to the Qualifications & Experience section above for full details.
Skills relevant to this position are outlined in the Qualifications & Experience section above. In general, strong communication, domain knowledge, and the ability to meet role-specific targets are valued across similar BFSI positions.
You can apply directly using the Apply Now button on this page, which will take you to Aditya Birla Group's application process for this role.