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Medical Case Coordinator

Medical Case Coordinator - IMMEDIATE HIRING

National General Insurance

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 Medical Case Coordinator Reviewed by Editor on December 22, 2018 Rating: 5
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