Claims Advisor
Posted on :
02-12-2024
Employer Active
1 Vacancy
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Job Description
- Receive client enquiries (General/ policy related) via email/ calls and provide clients with necessary support on their enquiries. Exceptional services (quicker TATs) provided to VIP members of the group
- Receive client complaints on delays in approvals for the medicines, and treatment procedures and coordinate with the Insurer to assist members by expediting the approval of treatments.
- Circulate monthly network updates and general circulars related to changes in the network.
- Reviews, understands, and assesses pre-approval assistance required by clients, informs all relevant parties of any potential problems or contentious claims, and seeks guidance or advice where necessary or refers to Claims Advisors/ Advocates to ensure the proper pre-approval of cases.
- Guides members on claims procedures to be followed for direct as well as reimbursement claims.
- Guides members on the claims process for home country or outside UAE treatment procedures and facilitates the approvals if mandatory as per the policy of the insured member.
- Portal submission assistance and resolution of portal issues.
- Prompt escalation of moderate/complex pre-approval cases to Claims Managers/ Senior Management to ensure effective outcomes as per client expectation
- Receives member calls and emails related to support required from a colleague who is out of the office and understands and redirects the enquiry to the concerned colleague responsible for handling the client in the absence of one colleague
- All urgent escalations outside office hours are managed in a timely manner and as per the services agreed to meet the expectations of the top clients
Employment Type
Full-time
Department / Functional Area
Key Skills
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