Manager - Outsourced Claims - Medi-Expert

1. Creating Panel of Doctors – Medi Experts

• Analyzing nationwide requirements of medical experts, identifying locations, MACTs
• Identifying MBBS/BHMS doctors for interviews with Panel & processing for finalizing.
• Participate in selection process to identify right candidate as medi expert
• Ensuring medical experts are getting continuous support and guidance.

1. Assignment of cases for Review, Evidence, Verification etc.:

• Identifying claims and appointing medical experts for evidence, court visit for document verification etc.
• Review of MIS, data, claims diary for identifying claims with exaggerated disability, fake & fraud bills
• Support & guidance to Medi experts in preparing for the Chief examination affidavit, preparing with case for evidence
• Review the claim diary on daily basis to evaluate, identify, and review matters coming for evidence in injury claims; Identifying maximum cases wherein medical experts can be utilized for leading evidence.
• Provide Technical Assistance as and when required to medi experts & team members
• Monitoring & Reviewing overall claims till closures and evaluating outcome.

1. Coordination with Stakeholders

• Support & guidance to medical experts for co-ordination with panel advocate, Execution & Approval team members.
• Coordinate with Advocates as and when required for claim inputs, judgments, support required etc.
• Provide input to team to address issues and remove roadblocks.

1. Evaluation & Development:

• Identify nonperforming/underperforming Medi experts; arrange for training through L&D Team; suggesting for de-panel if performance is not improved after efforts;
• Identify and create development opportunities for Medi experts to enhance knowledge, Technical skills etc;

1. Assessment of output:

• Assess the output of cases wherein Medi Experts have given evidence.
• Record cost vs. savings done by Medi Experts on case to case basis

Check on Claim Size Impact and take actions to minimize it

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