We investigate health claims including both cashless and the reimbursement cases. Cashless cases will be investigated and the reports will be submitted to the concern manager in a turn around time of less than 24 hours from potential area and in less than 36 hours from non- potential area. We are capable of maintaining a success rates between 45% to 55% , with a TAT of 80% to 100%.
All reimbursement cases are investigated and will be closed in a turn around time of 7 to 10 days . The reimbursement investigation includes member verification , hospital documentations , Family doctor , Treating doctor verification’s, Pathology lab verification’s , Pharmacy verification’s , Employment verification’s if applicable , Vicinity survey and past hospitalization documentations if any . The success rates are maintained between 45% to 65% in reimbursement cases with a TAT of 75% to 90%.
PA verification’s are handled by a team of people who are expertised in such claims and the final report is usually submitted in a TAT of 10 days . This includes the verification of the claimant, Accident spot , FIR , Post mortem verification’s, Vehicle inspections with documentation verification, Licence verification , vicinity survey , neighbor verification and Hospital documents if any. These cases are reported with a good success rates and TAT.
These kind of claims are investigated in a meticulous way so that the claimant and petitioner are verified , the actual loss evaluated and the same will be submitted with the supporting evidences . The technology plays an important role and the Field officers are meant for this cases separately who can manage and evade through the situations and other barriers from the petitioners. These kind of claims investigations has helped our clients to manage and reduce the risk of loss to the company.
These claims are investigated to verify and establish the Loss of Job as claimed by the insured. This includes the current employer verifications, past employment details, neighbour verification’s and a thorough vicinity survey.