Reimbursement claims, Pre-authorization, Direct Billing claims

Requirements & Responsibilities

• University Degree or Diploma in Nursing / Medical or medical practitioner.
• Min 4 - 8 years of experience (preferably relevant experience).
• Local candidates with valid QID preferred.
• Sound medical knowledge and willing to work in non-clinic process.
• Minimum of 1 year experience in handling authorization.
• Should be willing to work in shifts as the department works on 24 / 7 function.
• To manage and process claims ensuring documentation verifying eligibility obtaining necessary pre-authorization and facilitate billing for the reimbursement process.
• Provide accurate and timely medical claims handling services in accordance with company policies procedures and standards.
• Assess evaluate and process claims in an effective and efficient manner to support the smooth operation of the Claims function.
• Maintain detailed and accurate records of all claims assessments and decisions.
• Liaise with internal departments and external medical providers to gather necessary information for claim adjudication.
• Ensure compliance with regulatory requirements company guidelines and service level agreements (SLAs).
• Contribute to the continuous improvement of claims processes and systems.
• Be flexible in working across different types of Claims functions as assigned by management.

Employment Type : Full Time

Vacancy : 1

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