Medical Claims Assessor
Now Health International
United Arab Emirates
Responsible for providing our customers with a peerless service experience and claims journey by assessing and processing claims accurately and consistently. With a detailed understanding of the claims life-cycle from receipt to closure, the potholder will provide best-in-class customer service through high-quality correspondence and fulfillment of service promises.
Claims:
Deliver timely and accurate claims administration services: claims adjudication, data entry, production of claims correspondence such as claims settlements, declination, information requests, etc.
- Establish and maintain excellent knowledge of Now Health International’s products, claims handling procedures and systems (OH+).
- Assess claims as per defined work flows and delegated authority limits.
- Follow referral procedures on claims which are outside delegated authorities while dealing with medical review, case management, recovery claims, possible abuse & fraud and complete claim file.
- Able to makes sound judgment based on available claims information provided. Gives reason for decision made and ability to justify the same.
- Maintain records of large losses, ex gratis payments, major denials and support other routine and haddock reporting requirements.
- Adhere to all the KPIs listed below:
- Member Claims
- Claim settlement to client / customer within 5 days
- Process claim invoices within 3 days
- Request medical information within 3 days
- Provider Claims
- Claims settlement to provider within 15 days
- Process claims provider invoices within 10 days
- Request additional information within 10 days
- Adhere to and improve best practice processes across the claims operations, including the delivery of all the agreed service standards.
- Prepare regular claims report to meet the partners’ requirement
Online Jobs / Apply Today / Make Money
Medical Claims Assessor
Reviewed by Editor
on
December 17, 2018
Rating:
