An Medical Insurance Assessor

In the emerging insurance scenario in India, pricing and claim servicing will decide where an insurance company stands. In fact, in the days to come claim cost will have a direct bearing on the pricing. Leakages and frauds on account of claim / underwriting will adversely affect the claim experience, which in turn will affect the pricing. Because of the misdeeds of a few and because of the lack of effective control by the insurance company, the genuine policy holders, who constitute the majority, will have to pay higher prices for insurance products than is actually warranted.

According to a recent survey, it is estimated that the number of false claims in the industry is approximately 15% of total claims. The report suggests that the healthcare industry in india is losing approximately Rs.600-Rs.800 crores incurred on fraudulent claims annually. Health Insurance is bleeding sector with very high claims ratio. Hence, in order to make health insurance a viable sector, it is essential to concentrate on elimination or minimization of fake claims.

MEDINS evaluates the claims in all manner presented by the insurance policyholders and verify the authenticity of the insurance claim to protect the insurance company from swindlers and scammers. And check if the claims made by the policyholders are actually covered by the terms and conditions of their insurance policy.

While investigating the validity of the claims, we conduct a series of interviews with people involved in the claim aside from the policyholder, may include medical practitioners, police officers, eyewitnesses, or insurance agents.

By a team of health insurance assessors having excellent interpersonal, organizational, and analytical skills, ability to conclude with good judgment and able to distinguish counterfeit items from genuine ones.