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Medical Claims Assessor

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.

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

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Medical Claims Assessor Medical Claims Assessor Reviewed by Editor on December 17, 2018 Rating: 5
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