In Indian health insurance industry alone, it is estimated that around 20% of claims are fraudulent. With the number of fraudulent claims steeply increasing, the need for claims investigation is indispensable than ever. The steep increase in the incurred claim ratio is a pain point that hampers the claims settlement process altogether. The huge volume and geographical spread of claims and proves an obstacle for SIU`s (Special investigative units of insurers) to control this menace.
IFurthermore, it would be impractical and financially unviable for the insurer to deploy SIU`s at every part of the state. VR Assurance address this particular pain point for multiple insurers by deploying a network of credible claim investigators at each district for the states of Kerala and TamilNadu and Karnataka. Our investigators are qualified paramedics who are well trained in hospitalization claims investigation. On intimation from the nearest SIU of insurer, our software scans through our investigator network and allocates the case to the investigator closest to the claimant. Our Investigator physically visits the hospital and verifies the veracity of the claim. We check for both hard frauds (frauds committed by claimants) and soft frauds (frauds committed by hospitals with or without consent of claimants).
The value that we provide includes
The reports are submitted to insurer with facts and observation of the investigator along with recommendation of approval or rejection. Our reports are compliant with standards prescribed by Mr. Fred Wharton, CEO of North American Training Group. Our investigators hold CIAFP (Certified Insurance Anti-Fraud Professional) certification and have a success ratio of 80- 85% of the claims investigated.
For any further information regarding our claims investigation services, kindly get in touch with our CEO Mr.Gokul Krishna, Mob: 90723 28658