Role Summary:

To audit & process all type of rejected claims received by the payers and resubmitting them correctly after thorough investigation and justification.

Primary Responsibilities:

1.   Properly process and audit all type of claims received by the payers, from the medical and insurance perspective.

2.   Assure meeting the daily assigned target in terms of quantity & quality.

3.   Report back any type of claims observation or issues that may affect the process.

4.   Ensure that the medical ethics are respected at all times while performing the medical evaluation of the claims.

5.   Participate in developing the billing system by providing new ideas or proposal in order to enhance the process.

6.   Contribute in developing, updating and implementing the guidelines for evaluation and processing of medical claims, as well as policies and procedures and work instructions related to medical claims review and processing.

7.   Gather relevant information to clearly describe and properly escalate issues to insurance manager.

8.   Ensure high quality customer service and respect medical and work ethics at all times while conducting daily tasks.

9.   Ensure that business decisions and processes are documented in a professional way and the communication requirements are being adhered to in a timely and professional manner.

10. Conduct training to improve the technical, insurance and medical skills and knowledge for team members as assigned by insurance manager.

11. Provide all the needed support as advised by insurance manager based on the business need.

12. Other related tasks assigned by the line manager

Skills

Job Requirements:

·        Bachelor’s Degree in Medicine (MBBS) or any Bachelor’s degree in the medical/life science field.