1. Claims Audit:
   1. Review claims using regional and provider trends from fraud perspective
   2. Review medical abuse and overuse to negotiate with hospital
   3. Active negotiation to reduce claim size
   4. Create deterrent for future abuse/overuse with providers

2. Providers Audit:
   1. Study and analyse provider billing patterns
   2. Conduct provider medical audit basis findings
   3. Visit and audit provider’s record
   4. Create deterrent for future abuse

3. Live case negotiations
   1. Negotiate high value cashless claims with providers
   2. Conduct VC or concall to control claim cost

4. Underwriting audit:
   1. Analyse early claims for underwriting miss outs
   2. Audit underwriting decision
   3. Feedback to underwriters for future correction

5. Channel partners monitoring
   1. Study and analyse channel partners profitability
   2. Check analytical trends and claims collusion with providers
   3. Suggest corrective measures to improve profitability of partners

• Availability of quality data for analysis
• Avoiding investigator bias
• Negotiating with providers

• To de-empanel a provider basis findings
• To decide appropriate quantum of claim
• Accurately identify underwriting mis outs

Roles you need to interact with inside the organization to enable success in your day to day work           

• Claims, UW, Network team, Sales, ILM

Roles  you need to interact with outside the organization to enable success in your day to day work       

• Hospitals, Vendors, intermediaries, brokers , aggregators etc

• Annual savings of 1 cr per resource