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
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Medical Case Coordinator
Reviewed by Editor
on
December 22, 2018
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