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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