INSURANCE CLAIMS VERIFICATION SERVICES:

Insurance fraud is described as an intentional act - of deceiving, concealing, or misrepresenting information that results in healthcare benefits being paid illegitimately, to an individual or a group.

The purpose of investigation is to ascertain the authenticity and genuineness of referred suspicious claims basis the evidences collected thereby mitigating fraudulent activities and intent.

Insurance fraud costs the industry billions of dollars every year. It's a good thing Travelers knows how important it is to actively fight fraudulent activity. We consistently provide value-added service by developing national programs to aggressively detect and deter fraud.

Our Investigative Services team is spread across India, each holding advanced training and experience in the similar investigation vertical.

Whether you are looking for a complete end to end proposition or simply to apply our expertise at a specific part of your process, our specialist knowledge enables us to offer a flexible service tailored to your needs.

Our approach is focused on accurate risk assessment enabling quick identification of both suspicious and genuine claims. We understand the need to protect your customer’s experience whilst delivering significant claims indemnity spend benefit to you.

Our whole proposition is supported by market-leading intelligence and conversation management techniques.

WHY DO WE INVEST IN INSURANCE CLAIMS INVESTIGATIONS?

• To control the claim ratio (ICR – Incurred Claim Ratio)
• To understand the behavior of hospitals in Region
• To identify the adverse claims behavior
• To identify the nexus if any, between any hospital and agent/client or other intermediaries
• To confirm hospital eligibility as per the policy conditions
• To control prolonged hospitalizations and over-billing / overstay
• To find frauds and misrepresentations
• To find pre-existing ailments, OPD converted into IPD
• To find authenticity of claim submitted
• To find the existence of insured, any impersonation done.

We conducts extensive investigations to find out the fraudulent insurance claim activities which include the investigations checking for Contestable Investigations, Accidental, Fraudulent Claims, and Evidence Documentation etc. We are the Top Detective Agency in India and have helped many insurance companies by recognizing the fraud insurance claims made by other people, to recover false hefty insurance claims.