Investigator Officer

Job Responsibilities

Visit hospitals, clinics, pharmacies, diagnostic centres and other relevant locations for claim investigation.

* Verify the patient’s admission, treatment, diagnosis and discharge details from hospital records.

* Collect and verify all required patient documents, including medical records, bills, prescriptions, reports and other supporting documents.

* Conduct detailed inquiries with hospital staff, doctors, nurses, billing department and other concerned persons.

* Verify the authenticity of hospital records, admission details, treatment provided and billing information.

* Conduct patient-side verification and record relevant statements/details wherever required.

* Identify discrepancies, inconsistencies or suspicious information during the investigation.

* Complete the assigned investigation within the given timeline.

* Prepare a detailed investigation report along with all supporting documents and photographs/evidence.

* Compile the complete case file in PDF format and submit/update the same on the company portal or through the designated reporting system.

* Maintain confidentiality of patient and insurance-related information.

* Coordinate with the back-office team for any additional information or clarification required.