All About new joiner training module....

All About new joiner training module.

1. New Joiner Training Module Phoenix assurance private limited

2. About Our Company Phoenix Assurance Pvt Ltd is founded by Dr Rashmikant J Patel (MBBS, MPH) in year 2019, Phoenix Claim Solutions is a Proprietorship firm founded in 2014. We have vast Experience of 1.5 lac+ field claim investigation & document scrutiny in Indemnity and 17 lacs field claim investigation in PMJAY policy. The company has been honored with 10+ prestigious awards for our service and contribution in insurance sector.

3. Our Concept and Goal To make health insurance a viable sector by helping in reducing the health insurance claim ratio and in restoring the beautiful concept of insurance- ”sharing of the losses of few by many” and not letting it to be misused. To trace out and highlight the fraudulent activities or nexus operations. To ensure the health insurance benefits are reaching out the needy as needed, detecting the misrepresentation or concealment of facts and highlighting the exaggerated bills made on unrelated, unnecessary or fictitious testing or services. To stop insurance and medical service abuse. To contribute building in a genuine health industry, restoring the core values of empathy and equal medical assistance to all. Our Goal: Transparency, Accuracy, Integrity.

4. Scope of Growth with Us We are growing and there is increased scope for investigation in insurance  sector, since there is increase in uncertain risks to the human life with growing age, expectations, stress, population, pollution, luxurious lifestyle, competitive insurance business - relaxation in policy terms to attract large number and the awareness about  insurance. We have plan to expand, our network across India in next two years the case flow up to the double of current strength Note: The company was started with 100 case per month, and now we are closing 3000 cases per month, which is commendable growth!

5. Our Strengths We hold a very good team of doctors (MBBS + AYUSH) and field officers, all are  working with, Fair clinical knowledge Handy with health insurance terms and conditions and its applied aspect Knowledge of medical claim investigation triggers  Investigation with innovative ideas including gadgets and softwares. Adherence to quality. Adherence to turnaround time (TAT). Latest technology ensuring data security and confidentiality.

6. Standard Turn Around Time (TAT) For reimbursement claim verification, our TAT is for 4 days including Sundays and Public holidays, case will be completed in 4 days. The delay in TAT requires justification and  approval from SPOC. For cashless claim verification, our TAT is 4 Hours. Breaching TAT and company guidelines can be impact to our business, so we strictly adhere to it.

7. Functioning Cities & States Our Corporate Head Office is located in Ahmedabad, Gujarat. We are serving in 13 states at present across India, the states include, (1) Maharashtra, (2) Delhi, (3) Madhya Pradesh, (4) Gujarat, (5) Karnataka, (6) Andhra Pradesh, (7) Tamil Nadu, (8) Telangana, (9) Kerala (10) Jammu & Kashmir, (11) Rajasthan, (12) West Bengal, (13) Chhattisgarh

8. Manpower Count We are having 600+ employees working at PAN India level. 60 plus office team members including QC team and back office 50 plus doctors (MBBS+AYUSH) 250 plus field officers

9. Core Operational Areas We are associated with PMJAY, Public Insurance companies and Private Insurance companies for claim verification, MACT (motor accident claims tribunals) Claim, Motor Claims, Travel claims, Death claims, Personal accident claims. Health claim verification. Desk auditing and field verification of claims from government health schemes like PMJAY( Pradhan Mantri Jan Arogya Yojna) Ayushman Bharat. Manpower supply and auditing PMFBY (Pradhan Mantri Fasal Bima Yojana) claims.

10. Associated Companies We are working with 20 plus insurance companies and TPAs. The list of insurance companies includes ICICI Lombard (70%), Bajaj Allianz, Reliance, Care health/Religare, Tata AIG, Aditya Birla, HDFC Ergo, Zuno General Insurance company, Edelweiss Tokio Life Insurance, Universal Sompo, Liberty Videocon, Royal Sundaram, SBI, Cholamandalam, IFFCO Tokio, Kotak Mahindra, Magma HDI, Niva bupa. TPAs are Medi assist, Health India, FHPL, Onsurity.

11. Health Claim Workflow

12. PMJAY Workflow

13. Other Departments

14. Basics of Health & Healthcare Industry Please check attached PPt

15. Concept of Insurance – Health Insurance Please check attached ppt

16. All about Claim Investigation Please check attached ppt

17. Mastering Effective Communication Skills & Code of Conduct Please check attached ppt

18. Guidelines as per Role Please check attached ppt

19. Key Takeaways Try to inculcate talent to identify fraud at all levels (continuous nurturing is necessary). There is no secret recipe for cracking a fraud. Identify irrelevant charges and exaggerated charges to bring down excess payout. F ind facts that are not mentioned while taking the policy. Identify the facts and details which do not allow people to cheat the insurance company . Try to prove all manipulated cases as negative (and not to prove genuine cases as negative) G ather evidence to back our conclusion.