- Assesses approval of medical approvals as well as policy use.
- Checks treatment plan is necessary for the patient.
- Inputs verbal and written claims approvals regularly.
- Decides approvals as per policy conditions.
- Assess high-cost claims and provide decision on high cost and complicated cases.
- Provides clear feedback on queries from call Centre team.
- Provides clients an understanding of any declined medical claims.
- Coordinates workflow & meet deadlines.
- Evaluates claims with regards to eligibility.
Requirements
To be successful in this position you will need to have the following skills/ experience:
- Bachelor of MedicinePharmacyDentistry.
- 2+ years Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus).
- Legally permitted to work in the country of operations.
- Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.
- Strong verbal and written communication skills.
- Show flexibility, excellent interpersonal skills.