Filed Visit Officer

Role & responsibilities

Job Description Field Visit Officer (FVO)

Function: Health Insurance Claims Operations

Reporting To: Claims Manager / Regional Claims Head

Location: Field-based (Metro / Non-Metro)

Role Objective: Conduct timely field visits for health insurance claims to verify facts, collect accurate

documentation, identify fraud indicators, and support faster claim decisions while ensuring regulatory compliance

and positive customer experience.

Key Responsibilities:

• Conduct hospital, claimant, and residence visits for cashless and reimbursement claims
• Verify patient identity, hospitalization, treatment, and discharge details
• Collect geo-tagged photos, documents, and statements as per SOP
• Submit clear and factual visit reports within defined TAT
• Identify and escalate fraud or risk indicators with evidence
• Coordinate with hospital staff, doctors, and billing teams
• Interact professionally with insured members while maintaining confidentiality
• Adhere to IRDAI guidelines, internal SOPs, and data privacy norms

Key Performance Indicators (KPIs):

• Visits per day: 4–6
• Visit & report TAT adherence
• Report accuracy 98% and rework £3%
• Fraud flags quality and effectiveness
• Claimant satisfaction score 4/5

Qualification & Experience:

Graduate (preferred) with 1–4 years experience in health insurance claims, TPA, or hospital coordination.

Knowledge of medical terminology and hospital processes is an advantage.

Skills & Competencies:

Investigation skills, attention to detail, strong communication, integrity, ability to work independently, and proficiency

in smartphone-based reporting tools.