Operations Consultant

Insurance can  be a complicated business. That is why expert consultants can be a  great asset to the insurance needs of a company or to an insurance  business that needs guidance.
 

We provide technical audits, work flow analysis and seminars on team building, customer
relations and technical claims handling.

The different areas where you can attain benefits from our expertise as Consultants :

ENROLLMENT

• Receipt of data
• Entry in system
• Generation of enrolment cards
• Despatch of enrolment cards
• Invoicing
• MIS generation

CLAIMS 

• Technical accuracy
• Speedy settlement
• Data management
• Process development
• Development of claims manual
• Adjudication, authorisation and payment process
• Claims management specification
• Standards of performance and procedures
• Internal compliance
• IRDA compliance
• MIS generation at various level of process

AUDIT 

• Review and analysis of claims
• Strict scrutiny of underwriting conditions of the policy
• Strict scrutiny of accounting conditions of the policy
• Claim cost containment as per observed industry practice
• Anti fraud mechanism
• Audit program of IRDA

MEDICAL ADJUDICATORS 

• Appointment of specialty doctors
• Scrutiny of documents by doctors
• Management of cashless system
• Adjudication and authorisation of cashless claims

HOSPITAL NETWORKING 

• Development of hospital network
• Empanelment of hospitals
• Legalities of MOUs with hospitals
• Management of TAT
• Rate negotiation and development of PPN
• Relationship management
• Payment modalities of hospitals
• MIS for hospitals management

MIS MANAGEMENT

• Premium and claims statistics
• ICR management
• Analytical reports
• Tailor made reports
• MIS for insurer
• MIS for IRDA
• MIS for network hospitals

LEGAL 

• Claims litigation management
• Handling of legal cases at different forums

FRAUD DETECTION 

• Verification of validity of members
• Hospital visits
• Implementation of ICD coding
• Cross matching of drugs and procedures

INVESTIGATION 

• Investigation and scrutiny of claim
• Investigation and scrutiny of hospitals
• Verification of documents at various level
• Fraud detection mechanism

CUSTOMER CARE AND GRIEVANCE

• Customer relationship management and strategy
• Philosophies, methods and procedures of grievance management
• Development of customer feedback mechanism
• Development of 24 hours helpline for customer management
• Computerisation of call handling and registration
• Grievance registration
• Grievance redressal

LOGISTICS 

• Management of claim document movement
• Storage of claim files
• Indexing
• Retrieval and return of claim files to insurer
• Management of policy document movement
• Management of enrolment cards despatch
• Management of cheque despatch 
• Tracking of other documents
• MIS generation related to movement of all documents

DOMAIN ASSISTANCE TO SOFTWARE TEAM 

• Policy servicing
• Invoicing
• Statistics – IBNR and ICR computation
• MIS generation
• Develop, implement and maintain claims related applications for the company
• Archiving of data and images
• Implementation of underwriting conditions
• Fraud detection
• Manage productivity of staff and operations