HEALTH INVESTIGATION


Introduction

We ICS Assure Services Pvt. Ltd. (ICSAS) are providers of Health Claim Investigation Services to our valued clients across the country. We provide Health Claim Investigation Services in cases where the health insurance policy is provided by all insurance companies are misused to fraudulently claim money. We provide our services for Health Claim Investigation using well-developed methods that ensure good results. We make Health Claim Investigation Services available to well recognized insurance companies. Objective of Health Claim Investigation services provided by us are to ascertain the authenticity and genuineness of referred suspicious claims basis the evidences collected thereby mitigating fraudulent activities and intent.

A. Spot

B. Cashless and Full

C. Reimbursement

Areas explored while investigating a claim are as Insured's residence, Vicinity check, Neighbor check, Chemist / hospital / doctor, Hospital check, Employer check, Treating consultant, Pathology, Pharmacy, etc.

Benefits:

1.Empowered Expert Claims (Medicos) Assessors All cases received for investigation are assigned to an Expert Claims Assessor (ECA) to manage the case from an end-to-end basis.

All the assessors at ICSAS are doctors and loss mitigation experts with experience of assessing insurance claims.

2. Plan of Action The ECA reviews each case and prepares a Plan of Action for the Field Officer to follow.

Real Time ECA support to trained field officers Duly trained FOs have been empowered on what exactly to look for and in art of subtle questioning. When the FOs are on the field, they are provided with real time support and the case is monitored by the assigned ECA.

3.Evidence Based Conclusion Our conclusions are supported by evidence (attested documents, statements, recording, photographs, etc)

4.Rigid adherence to TAT Designated TAT officer to track all TATs with process driven triggers to escalate thus ensuring closure within stipulated time.

5.Final report with valuable inputs Final reports are prepared by ECAs and claim management experts with valuable inputs for Insurance companies to adjudicate the case in a rational manner taking both customer service and fraud issues into consideration.

6.Independent Quality Control Robust independent internal control system to ensure adherence to Quality standards.


About ICS Assure

ICS Assure Services Pvt. Ltd.(Forensic Unit) provides a 360° solutions to Private companies and Govt. Sectors in in assisting and solving the Criminal and Civil cases.

Contact center

22/23, Goodwill, Swastik Estate, 178 CST Road, Kalina, Santacruz (E),

  • Monday - Saturday, 9am to 6pm
  • +91 22-42200900
  • info@icsaspl.org
Our location

22/23, Goodwill, Swastik Estate, 178 CST Road, Kalina, Santacruz (E), Mumbai-400 098, Maharashtra, India.

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