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Health Claims Investigations

Cashless / Pre auth Claims

We investigate health claims including both cashless and the reimbursement cases. Cashless cases shall be investigated and the reports submitted to the concerned 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%


Reimbursement Claims

All reimbursement cases are investigated and closed in a turn around time of 7 to 10 days . The reimbursement investigation includes member verification , hospital documentations , Family doctor and 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%


Personal accident Investigations

PA verification's are handled by a team of people who expertise 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 and Post mortem verification's, Vehicle inspections with documentation verification, Licence verification , vicinity survey , neighbor verification , Hospital documents if any. These cases are reported with a good success rates and TAT.


Motor PA and Third Party Investigations

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 submitted with 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


Loss of Job Verification's

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.