Medical Case Coordinator

Medical Case Coordinator - IMMEDIATE HIRING

National General Insurance

Dubai

Overall Duties include:

Attending to customer queries related to policy wordings and their pending claims or approvals with time limit of 5-10 minutes on every call.
Providing verbal and written approvals through email and online portal on daily time basis.
Responding to calls from pharmacies and modify PBM based on the policy wordings.
Processing exclaims and paper claims after screening base on agreed tariff at the same time tallying at the end of the month.
Coordinating with the medical team with regards to member’s complaints and queries.
Provide customers/provider with real time updates on their approval requests and medical cases.
Evaluate pre-approval for in-patient and out-patient according to policy terms and conditions, financial limits and validated in the claims management system.
To request further clarification from the provider, issue approval or rejection depending upon the medical request received.
To give Pharmacy approvals on PBM system.
Exercise cost containment approach when managing approval requests.
Process and check claim forms and E-claims according to prescribed guidelines or policies
Process claims using the provider’s agreed contract rate.

Compulsory note:

Duty with Roster Shifts 24/7 and 2 days off in a week . Any additional tasks assigned by manager. The job description is subject to change at point in time as per changing business need and management discretion on the same

Online Apply