Health claims investigation

In Indian health insurance industry alone, it is estimated that around 30% of claims are fraudulent. According to studies conducted by FICCI and Indiaforensic, 31% of medical bills and documents submitted for the purpose of securing health insurance claim have been found to be fraudulent. The increase of fraudulent health claims is posing a challenge to insurers in claim settlement pace. With emergence of hardcore insurance frauds, even paper hospitals, the need for claims investigation is indispensable than ever.

The steep increase in the fraudulent claim is a pain point that hampers the claims settlement process altogether and threatens the incurred claim ratio and the financial strength of the insurer. The huge volume and geographical spread of claims and proves an obstacle for SIU`s (Special investigative units of insurers) to control this menace.

Furthermore, 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. 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 checks 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:
Best turnaround time in claims investigation industry
Well qualified and professionally competent investigators
In house fraud detection software for red flags as soon as claim is received
Proven track record with over 8 years in the industry and 10+ clients.
Lower claims outgo and enormous savings in claims for the insurer
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 from Insurance Institute of India and have a success ratio of 80- 85% of the claims investigated.

For any further information regarding our health claims investigation services, kindly get in touch with our CEO Mr. Gokul Krishna at +91 9072328658

Motor claims investigation

Motor TP Insurance has always been a bleeding portfolio in the insurance industry. With structured compensation amendment being implemented, the moral hazard for fraudulently claiming a motor TP increases multifold.

With advancement in technology, multiple methods of defrauding an insurer have emerged. Collusion between insured and claimant, exaggerated claims made by claimant, driver/vehicle swapping, fake accidents and addition of passengers for the sole purpose of insurance claim are some of the ways by which motor TP fraud happens.

We offer a comprehensive solution for fighting motor TP frauds. Our state-of-the-art IT system finds inconsistencies between various documents when uploaded in the system. Our investigator network is spread throughout Kerala and TamilNadu. As soon as we receive a case, our IT system allocates the case along with red flags to the nearest available investigator. Our investigation team is spearheaded by Retd Dysps and Ex-police personnel. We not only collect the relevant records from concerned authorities but also ensure that accident spot investigation is conducted and verify the actual events from witnesses wherever possible.

For high value cases we make sure that the income provided in petition is verified and any inconsistencies are immediately brought to the notice of the insurer. All of our reports are triple checked for quality and submitted before end of TAT (Turn around time) provided by the insurer. Our IT system enables us to customize formats of the report as desired by the insurer.

We have handled more than 7000+ motor TP cases and have a proven record for detecting false cases as well as substantiating our repots with conclusive and irrefutable evidence.

For any queries on our Motor TP investigation services, kindly get in touch with our CEO Mr. Gokul Krishna at +91 9072328658

Diagnostics and lab management

We Are Lab+ Profit Solutions from VR Assurance empowers your lab with wider visibility and reach through dedicated websites and helps you enhance profitability with real-time and efficient information system, secure and patient friendly access to clinical reports and quicker turnaround times.

WE ARE Lab+ Profit solutions equips labs with dedicated, custom made website with in-built information management system that can automate and streamline laboratory documentation and information management. Highly scalable and configurable platform, WE ARE Lab+ Profit solutions is designed to diverse and dynamic needs of modern labs by leveraging the real-time power and security of technology.

The real-time Lab+ Profit solutions is backed by 24x7 monitoring and services by a team of experienced technology experts, laboratory business professionals and profitability analysts.

Features:
Enhanced visibility and reach through responsive websites.
Dedicated website to reach and on-board customers.
Secure and scalable platform to store, manage and retrieve clinical information.
24x7 secure access to patients and doctors to view and download reports.
User friendly GUI, built in dashboards.
East integration of features such as billing, pre-insurance medical screening, claim settlement, loyalty packages, discounts, reimbursements.
East integration of legacy business systems.
Automatic promotions, alerts and reminders to patients and doctors.
Can share information sharing between patients, labs and doctors easy and faster.
Highly secure and scalable.
Add on configurations in minimum time.
Report generation and analysis for better profit management.

Services:
Website hosting, designing and content management.
Technical support.
Scanning and uploading of physical documents for labs without computers or internet.
Complete database to manage customers and analyze customer preferences.

Benefits:
Incremental revenue through website leads and cross referrals.
Easy integration and promotion of special offers, launch of new products and services and differentiated branding.
Tie-ups with insurance companies with opportunity to increase profit margins by offering pre-insurance medical screening.
Improved turnaround time for test result delivery.
Real-time, secure and free access to clinical reports for patients and doctors for 6 months.
Improved transparency to lab work status.
Flexibility to accommodate new requirements.
Flexible and upgradeable system that delivers compelling results.
Reduce system maintenance and administration expenses.